Casualties and Medical Statistics (History of the Second World War United Kingdom Medical Series)

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HISTORY OF
THE SECOND WORLD WAR

UNITED KINGDOM MEDICAL SERIES

This volume of the Official Medical History of the Second World
War has been prepared under the direction of an Editorial Board
appointed by Her Majesty’s Government, but the authors alone
are responsible for the method of presentation of the facts and the

opinions expressed.

CASUALTIES
AND
MEDICAL STATISTICS

EDITED BY
W. FRANKLIN MELLOR

LONDON
HER MAJESTY’S STATIONERY OFFICE
1972

Medics! Library

RC
971
M55

First published 1972

© Crown copyright 1972

Printed and published by
HER Mayjesty’s STATIONERY OFFICE

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EDITORIAL BOARD

Sir WeLpon DaLryMpLe-CHampneys, Bart., \ Ministry of Health
C.B., M.A., D.M., B.Ch., F.R.C.P.

J. F. H. BROTHERSTON, M.A., F.R.C.P. Ed., F.R.S.E. Department of Health for

A. K. BowMan, M.B., Cb.B., F.R.F.P.S. Scotland
Government of Northern
F. F. MAN, M.B., Ch.B., F.R.C.P. Ed. Treland

Sir Harotp HimswortH, K.C.B., M.D., F.R.C.P.,
P.R.S. Medical Research Council

Dame JANET VAUGHAN, D.B.E., D.M., F.R.C.P.

Surgeon Vice-Admiral E. B. BRADBURY, C.B., \ Admiralty
Q.H.P., M.B., B.Ch.

Lieut.-General Sir NorMAN TALBOT, K.B.E.,
T.D., Q.H.S., M.D., F.R.C.0.G.

Major-General A. SACHS, C.B., C.B.E., Q.H.P., War Office
M.Sc., M.D., M.R.C.P.

Air Marshal Sir Grorce R. Gunn, K.B.E., C.B., Air Ministry
Q.H.P., M.B., Ch.B., M.R.C.P. (Edin.)

Brigadier H. B. LarHam Cabinet Office

Editor-in-Chief: Sir ARTHUR S. MacNALTY, K.C.B.,
M.A., M.D., F.R.C.P., F.R.C.S., F.S.A.

Secretary: W. FRANKLIN MELLOR

The following persons served on the Editorial Board for varying periods:

The Rt. Hon. Lord Butler of Saffron Walden, p.c.; Sir Cyril Flower,
C.B., F.S.A. (Chairmen); Brigadier-General Sir James E. Edmonds, C.B.,
C.M.G., D.Litt. (Committee of Imperial Defence); Surgeon Vice-Admiral
Sir Sheldon F. Dudley, k.c.B., 0.B.E., M.D., F.R.C.P., F.R.C.S. Ed., F.R.S.;
Surgeon Vice-Admiral Sir Henry St. Clair Colson, K.C.B., C.B.E., F.R.C.P.;
Surgeon Vice-Admiral Sir Edward Greeson, K.B.E., C.B., M.D., Ch.B.;
Surgeon Vice-Admiral Sir Alexander Ingleby-MacKenzie, K.B.£., C.B.,
Q.H.P., B.M., B.ch.; Surgeon Vice-Admiral Sir Cyril May, K.B.E., C.B.,
M.C., Q.H.S., F.R.C.S.; Surgeon Vice-Admiral W. R. S. Panckridge, c.B.,
Q.H.P.; Surgeon Vice-Admiral Sir Derek Steele-Perkins, K.C.v.0., C.B.,
Q.H.S., F.R.C.S.(Eng.), F.R.A.C.S., D.L.O.; Surgeon Vice-Admiral E. D.
Caldwell, C.B., Q.H.P., M.D., Ch.B., F.R.C.P. Ed. (Admiralty); Lt.-General
Sir William P. MacArthur, K.C.B., D.S.O., 0.B.E., M.D., B.Ch., D.Sc., F.R.C.P.}
Lt.-General Sir Alexander Hood, G.B.E., K.C.B., M.D., F.R.C.P., LL.D.;
Lt.-General Sir Neil Cantlie, K.c.B., K.B.E., C.B., M.C., M.B., F.R.C.S.;
Lt.-General Sir Frederick Harris, K.B.E., C.B., M.C., Q.H.S.,M.B., LL.D.; Lt.-
General Sir Alexander Drummond, K.B.E., C.B., Q.H.S., F.R.C.S., D.L.0.;

v

vi

EDITORIAL BOARD

Lt.-General Sir Harold Knott, K.C.B., 0.B-E., Q.H.P., M.A., M.D., LL.D.5
Major-General H. M. J. Perry, C.B., 0.B-E.s F.R.C.P.} Major-General L.
T. Poole, C.B., D.S.0., M.C., M.B.» ch.B.; Brigadier Sir John Boyd, 0.B.E.,
M.D., F.R.S.5 Brigadier H. T. Findlay, M.B., Cb.B.; Lieut.-General Sir
Robert Drew, K.C.B., C-B-E., Q.H.P., M.B.,F.R.C.P. (War Office); Air Marshal
Sir Harold E. Whittingham, K.C.B., K.B.E., M.B., Ch.B., F.R.CP., FRCS.
LL.D.; Air Marshal Sir Andrew Grant, K.B.E., C.B.. M.B., Cb.B.; Air Mar-
shal Sir Philip C. Livingston, K.B.E., C.B., A.F.C, F-R.C.S.5 Air Marshal Sir
James M. Kilpatrick, K.B-E., C-B., Q.H.P., M.B., B.Ch.} Air Marshal Sir
Patrick Lee Potter, K.B.E., Q.H.S., M.D., D.T.M. & He; Air Marshal Sir
Richard Nelson, K.C.B., 0.B.E., Q.H.P., M.D. (Air Ministry); Sir Edward
Mellanby, G.B.E., K.C.B., M.D., F.R.C.P., F.R.S. (Medical Research Council);
Professor J. M. Mackintosh, M.A., M.D., F.R.C.P.5 Sir Andrew Davidson,
MD., F.R.C.P. Ed., F.R.C.S. Ed.5 Sir Kenneth Cowan, M.D. (Department of
Health for Scotland); J. Boyd, C.BE., M.D. F-R-C.P.I. (Government of
Northern Ireland); Lt.-Colonel J. S. Yule, 0.B.E., Philip Allen, Esq.,
G. Godfrey Phillips, Esq., M. T. Flett, Esq., A. M. R. Topham, Esq.,
D. F. Hubback, Esq., A. B. Acheson, Esq., C.M.G., C-B-E- (Cabinet Office);
Sir Francis R. Fraser, M.D., F.R.C.P. (Ministry of Health).

EDITORIAL COMMITTEE

Sir ArTHUR S. MAcNALTY, K.C.B., M.A., M.D., F.R.C.P., F.R.C.S., F.S.A.
(Chairman)
Surgeon Captain J. L. S. Courter, p.s.c.,
F.R.C.S. (Barrister-at-Law) }
Professor F. A. E. CREW, D.Sc., M.D., LL.D.,
F.R.C.P. Ed., F.R.S. \
Group-Captain S. C. RExFoRD-WELCH, M.A.,
M.Sc., M.R.C.S., L.R.C.P.

War Office

\ Air Ministry

Department of Health for
A. K. BowMan, M.B., Ch.B., F.R.F.P.S, ‘Scotland

Government of Northern
F. F. MAn, M.B., Ch.B., F.R.C.P. Ed. Treland
F. H. K. Green, C.B.E., M.D., F.R.C.P. Medical Research Council
A. SANDISON, 0.B.E., M.D. Ministry of Pensions
Sir ZacHary COPE, B.A., M.D., M.S., F.R.C.S. Ministry of Health

Secretary: W. FRANKLIN MELLOR

The following persons served on the Editorial Committee for varying
periods:

Surgeon Commander J. J. Keevil, p.s.o., m.D.; Surgeon Lieutenant
L. D. de Launay, M.8., B.s.; Surgeon Lieutenant-Commander N. M.
McArthur, M.D.; Surgeon Commander A. D. Sinclair, M.B., Ch.B.
(Admiralty); Colonel S. Lyle Cummins, ¢.B., C.M.G., LL.D., M.D. (War
Office); Wing Commander R. Oddie, M.B., B.ch.; Wing Commander
E. B. Davies, M.B., B.ch.; Squadron Leader R. Mortimer, M.B., B.S.;
Squadron Leader H. N. H. Genese, M.R.C.S., L.R.C.P. (Air Ministry);
J. Boyd, C.B.E., M.D., F.R.C.P.1. (Government of Northern Ireland);
Charles E. Newman, C.B.E., M.D., F.R.c.P.; N. G. Horner, M.D., F.R.C.P.,
F.R.C.s.; Lt.-Colonel C. L. Dunn, c.1.£.,1.M.s. (Ret.) (Ministry of Health);
J. Alison Glover, C.B.E., M.D., F.R.C.P. (Ministry of Education).

FOREWORD

By SIR AUSTIN BRADFORD HILL, c.B.£., F.R.8.,
Ph.D.(Econ.), D.Sc.(London), Hon. M.D.(Edin.)

been swayed not only by military skill and valour but by disease and,

in particular, epidemic disease. The Second World War was no
exception though on the whole its characteristic was the prevention
rather than the promotion of illness. We experienced, both in civil and
military life, nothing akin to the violence of the 1918-19 influenza
pandemic of the First World War—one of the great pandemics of all
history. On the other hand but for the virtual conquest of malaria many
a campaign in the Far East would have foundered. Nearer home we saw
the almost startling development of infective hepatitis as an epidemic
phenomenon in the troops. From all the Services we saw invaliding rates
no longer swollen by tuberculosis but by peptic ulcersand psychoneuroses
and so on.

Many an earlier volume in this Official Medical History of the Second
World War has sought these factual data in developing its story. Now
in this present and final volume the statistics are all brought together
and set out in detail, not only, one hopes, to record the past but to serve
as a guide to future planning and research. For instance, in spite of all
the changing conditions of warfare, they should continue to illuminate
the problems of Service wastage—the invaliding that takes place at
particular stages of life, in particular occupations and from specific
causes. They should certainly indicate how essential is a good system
of recording sickness and injury in peace-time, not only for admini-
strative reasons but for the contribution that a knowledge of these events
should be able to make to epidemiology and therapeutics. For, while
statistics may not often solve problems they are one of the most fruitful
starting points by merely portraying a problem and thus leading to
research.

The statistics here presented are, of course, incomplete. Under the
conditions of war they could hardly be else. Yet on the whole one is
impressed by all that was done to compile returns, in situations often of
great difficulty and hardship and by the skill with which, at the centre,
sampling procedures were called to aid in analysing data that reached an
almost astronomical scale.

Some of the results here set out certainly make surprising reading.
Thus in an account of the work of the Royal Naval Hospital, Haslar
(Portsmouth) it is reported that in the early years of the war it was under
continuous threat of bombardment from the air and all but the most

I: IS A TRUISM that throughout history victory or defeat in war has

ix
1*cMS

x FOREWORD

seriously ill patients were evacuated every night to cots in the cellars.
Meanwhile the hospital staff went to their action stations during the
fairly numerous air-raid alerts. Yet both patients and staff appeared to
thrive under this routine!

In similar vein the Royal Air Force records that with a rapid increase
in strength in the first months of the war peace-time standards of accom-
modation went by the board—the floor space per man in barrack room
or hut was halved and many a hut was draughty, ill-ventilated and
inadequately heated. The problem of providing a balanced and satisfying
diet was considerable; the ordinary hygiene of sewage disposal on new
sites was yet another. Increased hours of work were inevitable. The
winter of 1940 was very severe. Yet the sickness rate in 1940 hardly rose
above the previous year’s peace-time level.

It is good to have the figures to illustrate such, and many other,
remarkable events. In this volume, too, they relate not only to the
Fighting Services as of yore but also to a civil population that had
itself to face many of the dangers of total warfare. The statistics for the
Emergency Medical Services round off this numerical account of the
medical stresses and demands of the Second World War.

CONTENTS

Page
FoREWwoRD SIR AUSTIN BRADFORD HILL, c.B.£., F.R.s.,
Ph.D. (Econ.),D.Sce (London), Hon. M.D. (Edin.) ix
PREFACE és 5 , : ; 5 4 c ; . xiii
THE ROYAL NAVAL MEDICAL SERVICES é : ‘ I
SURGEON CAPTAIN F. P. ELLIS, 0.8.£., Q.H.P., M.D., F.R.C.P.,
R.N.
THE ARMY MEDICAL SERVICES . 7 ‘ 6 + gt
MAJOR H. G. MAYNE
THE ROYAL AIR FORCE MEDICAL SERVICES . - 455
GROUP CAPTAIN S. C. REXFORD WELCH, s.a., M.Sc.,
M.R.C.S., L.R.C.P.
THE EMERGENCY MEDICAL SERVICES . 4 - 635
EILEEN M. BROOKE, .sc.
ANNEXURE
Strength and Casualties of the Armed Forces and ssa Services
of the United Kingdom, 1939-45. F 827

(Her Majesty’s Stationery Office, Cmd. 6832, ai
INDEX ‘ . 5 ; , 7 . . A é - 841

xi

PREFACE

HE PREPARATION of this volume, as with its counterpart after
Te First World War, was beset by many difficulties, some of

which are referred to in the Introductions to the three Fighting
Services’ contributions. Among these difficulties were the loss of
documents in transit owing to enemy action, fast-moving warfare
leaving little time for medical recording and the inexperience of some
Service Medical Officers. Moreover, in retreat or defeat, e.g. Norway,
Greece, Crete and the early years in the Middle East campaign,
adequate documentation could hardly be expected.

The Army statistics, based mainly on hospital admissions and not on
the Field Medical Cards, many of which were lost, cannot in
consequence present a complete picture. For it was to the Field Medical
Units that most of the casualties and sick came in the first place. It is
from their records that a more complete account of the numbers of
casualties that occurred, the types of injury or ailment, the treatment
given, disposal, etc., might have emerged. Treatment in Field Medical
Units was such that a sizeable proportion of casualties did not need to
be sent to hospital. Thus, treatment of casualties in the field—an
important feature of the Army Medical Services’ successful achieve-
ments during the Second World War—is not fully recorded here.
Sample statistics of the work of some of the medical units will be found
in Army Medical Services, Campaigns, Vols. I-V in this series; the
evolution and changing functions of these units during the war years
are described in Medical Services in War (pp. 104-142), the penultimate
volume of this series.

In the United Kingdom, for the first time, it was found necessary to
set up an organisation to deal with casualties and sickness among
civilians and Service personnel in a population exposed to air attack and
the threat of invasion. This organisation—the Emergency Medical
Services—was unique and the review of its work here holds special
interest.

A great deal is owed to the contributors to this volume for all the
time and painstaking effort they devoted to the preparation of their
respective sections. The result is an impressive overall picture of the
diseases and injuries sustained by the members of the United Kingdom
Armed Services and the civilian population during the war years.
Other data concerning particular diseases and types of injuries in
specific Commands and Campaigns will be found in the relevant
Service volumes of this History.

The production of a work of this kind was not without its frustrations
and complications. I am indebted to Miss F. E. E. Harney, of the

xiii

xiv PREFACE

Department of Health and Social Security, for sharing the editorial
work and for her help in piloting the volume through the press. As in
the case of previous volumes of this History, her loyalty, ability and
dedication to the work in hand have been of rare quality.

W.F.M.

The Royal Naval Medical Services

MEDICAL STATISTICS

by Surgeon Captain F. P. Ellis,
O.B.E., Q.H.P., M.D., F.R.C.P., R.N.

CONTENTS

INTRODUCTION

Tue SeconD WorLD War . A : ;
I. The Total Force . 5 :
Table 1. Morbidity, Tsaindige aad’ Mortality Rates foe Diseases

and Injuries, 1936, 1939°45 and 11983 ue casual-
ties in action) 5

Table 2. Common Disease ce for Officers and es ase
1939-45

Table 3. Invalidings—Respiratory Tuberculosis, Psychoneuroses
and Psychoses, Peptic Ulcer, Diseases of the ee 36
1939-45 and 1953 .

Table 4. Total Force. Diseases and Injuries, Invalidings and
Deaths; Average Number of Men Sick Bae Numbers
and Ratios per 1,000, 1939

Tables. . “ 2 ° a gee . 1940
Table 6. . i 5 . ‘lero . 1941
Table7, . z % e aahe + 1942
Table8. . : ‘ 3 ‘ 7 Biota + 1943
Tableg. : ; mn ‘ : re + 1944
Table 10... 3 Ny mo + 1945

IL. INVALIDINGS DUE TO DISEASE AND DEATHS DUE TODISEASE.

Foreword by Professor Major Greenwood, F.R.S., D.Sc., F.R.C.P.

14

15

52

R.N. An Analysis of Invalidings due to Disease and Deaths due to Disease

1934-44 by Surgeon Commander J. A. Fraser Roberts, R.N.V.R.
General Summary . . : . .
General Notes on the Tables . : :
Tables showing Invalidings due to Disease
Officers excluded :
Table 11. Annual Totals by Age Groups.
Table 12. Annual Totals by Disease Groups
Table 13. Pulmonary Tuberculosis
Table 14. Epilepsy .
Table 15. Psychoses, Paychaneuccses and Mental Désideaey
Table 16. Diseases of the Eye

3

55

55
59

4 CONTENTS

Table 17. Diseases of the Ear ‘
Table 18. Diseases of the Circulatory System .
Table 19. Bronchitis . 2 : 7 . .
Table 20. Peptic Ulcer.

Table 21. Arthritis

Tables showing Invalidings due to Disease
Officers
Table 22. Total Annual Rates i
Table 23. Annual Totals by Disease Gini 3
Tables showing Deaths due to Disease
Officers excluded
Table 24. Total Annual Rates 5
Table 25. Annual Totals by Disease Groupe J
Table 26. Totals by Age and Disease Groups .

Tables showing Deaths due to Disease.
Officers
Table 27. Total Annual Rates : . : .
Table 28. Totals by Disease Groups

W.R.N.S. An Analysis of Invalidings due to Disease and Deaths
due to Disease, 1941-43
Notes on the Tables

Table 29. Annual Totals by Disease Groups

Table 30. Totals by Age Groups

Table 31. Comparison of Men and Worn in eon to

Invalidings due to Disease
Table 32. Deaths due to Disease .

III. Royat Navat HospiTat, HASLAR

Table 33. Total Admissions in the First and Second World
Wars

Table 34. Admissions dating the First ney Bacon World
Wars for certain Disease Groups

Table 35. Admissions for Peptic Ulcer, 1939-45

Table 36. Skin Diseases in the two World Wars

Table 37. Diseases of topical interest, 1939-45

Table 38. Nosological table showing number of pisicnte
treated during the First and Second World Wars.

CONCLUSION . . 5 5 - 5 < . ‘

REFERENCES

INTRODUCTION

EFORE the year 1830 the numbers of men voted and returns of
naval personnel killed and wounded were the only official stat-
istical documents published by the Admiralty. Regular annual

returns of deaths in ships of the Fleet were not required until 1810.
The best statistical account of mortality, during the War of 1793-1815,
was that prepared by W. V. Hodge’ who based his figures upon extracts
of the log books of ships compiled by William James.? In 1840 the
Admiralty published annual statistical reports on the rates of mortality,
invaliding and sickness for the years 1830-36 and after 1856 these
statistical reports were collated and published by Her Majesty’s
Stationery Office, with certain exceptions, in the form of an annual
Report of the Health of the Navy. These Reports made possible com-
parisons over the years between death rates, invaliding rates, incidence
rates of diseases and the loss of time from sickness of various kinds. The
figures set out refer not merely to the Fleet as a whole, but also to the
various Stations where the Fleet was employed.

Although this annual statement was prepared with increasing care
with the passage of years there was no separate section which applied
to naval officers; and it was not until the year 1938 that routine medical
examinations were instituted and medical history documents main-
tained for naval officers and then only for aircrew. The naval officer had
nothing similar to the Medical History Sheet of the rating. Thus,
until a relatively short time ago it was possible for an officer to serve
throughout the whole of his career with no medical examination apart
from that carried out at the time when he was originally found fit to
enter the Service. If he were to go sick in the course of his Service
career there was no system for recording such an illness except in the
medical returns of his ship or establishment, or in the books of any
naval hospital in which he might be treated, and there was no system for
the collation of officers’ medical records in one single file which would
be available for scrutiny.

The principal sources of data available to the Medical Director-
General in compiling the annual Report of the Health of the Navy were
the quarterly journals of medical officers. Regulations required the
senior medical officer of every ship and establishment to forward a
quarterly journal to the Medical Department of the Admiralty through
his commanding officer. This journal was divided into various tables,
which included the movements of the ship, alphabetical sick list,
clinical details of cases sent to hospital, injuries and general remarks
on the state of health of the ship’s company as a whole. Details of
sickness from the various diseases were recorded in nosological tables

5

6 INTRODUCTION

covering the total number of cases, the number invalided, the number
dead, the number sent to hospital and the total days’ sickness accord-
ing to an approved system of nomenclature.

It was inevitable, especially during war-time, that for various reasons
(the medical officer himself might have been a casualty) some quarterly
journals were incomplete or the journals themselves might be lost or
destroyed by enemy action. In the case of some casualties the only
notification received in the Medical Department would be a signal sent
from the surviving naval authorities in the area. Such signals, required
for notification of next-of-kin, pension awards, etc., would contain little
or nothing in the way of clinical details; they would in general also
contain the numbers of only the more seriously injured or dead. The
figures given in Table 6 of Command Paper 6832 (Casualties of the
Armed Forces, 1939 to 1945)* which shows the number of seriously
wounded and killed in the Royal Navy in the Second World War were
in fact culled from these signals. These totals vary from the totals
shown in Tables 4-10, derived from the more detailed medical officers’
quarterly journals. When ships were lost in action no records of the
actual causes of death would be available for many of the casualties.
In view of this the numbers who died in action were excluded from the
above mentioned tables except for the years 1939 and 1940 and even
these should be regarded as only approximations.

At the beginning of this survey it was stated that annual medical
statistical reports were made since the year 1856 ‘with certain excep-
tions’. The first documentary reference in the present century to such
an ‘exception’ occurs in September 1915. At that time, the question of
security was raised and the Board of Admiralty concluded that such
annual statistics might disclose to an enemy valuable information about
the organisation and movements of the Fleet. It was agreed that although
medical statistics would still be compiled they would not be published
until after the end of hostilities and no naval medical statistics were
published during the First World War. Unfortunately owing to admin-
istrative difficulties, not the least of which was shortage of clerical
man-power, problems also arose concerning the collation of naval
medical statistics during the later years of the war and led to the indefinite
postponement of publication of the figures for the years 1916-18. These
figures were never abstracted from the journals which were ordered to
be stored as permanent records. The system having broken down, it
took some time to resuscitate it once the First World War was ended.

During the period between the wars the Statistical Report of the
Health of the Navy was published annually in the normal way from
1921 onwards. In June 1938, the suspension of publication during the

* See Annexure, p. 827.

INTRODUCTION 7

course of the First World War was noted and the question of the future
was raised. After consultations with the Army and the Royal Air Force
Medical Departments, it was agreed by September 1938 that in the
event of war the official Statistical Report on the Health of the Navy
would be withdrawn from publication and sale, but a report in modified
form would be prepared in conformity with the approved procedures
of the War Office and Air Ministry.

THE SECOND WORLD WAR

With the outbreak of the Second World War it was decided that:

(1) publication of the Report of the Health of the Navy for the years
1937 and 1938 would be held over until the end of hostilities;

(2) reports for the war years might be compiled inside the Medical
Department of the Admiralty but their publication would also be
held over until the end of hostilities.

During the next six months the Medical Director-General was able
to gain some idea of the difficulties which lay ahead in compiling
medical statistics under war-time conditions, particularly if the war
should last any length of time. By the end of the year 1939, 1,020
Journals had been received from medical officers and a revised organisa-
tion was obviously needed if the figures for disease and injury were to
be extracted expeditiously. At the same time, scrutiny of the numerous
journals from medical officers serving afloat revealed the difficulty of
allocating any particular ship to a specified fleet or station in any given
part of the year.

In peace-time, the journal of every medical officer included a table
showing the movements of the ship. This permitted outbreaks of sickness
in a ship to be associated with a particular station or port. As a security
measure in the Second World War, the movements table was eliminated
and it thus became impossible to study endemic or epidemic illnesses
on a geographical basis.

In May, 1943, a Naval Medical Statistics Committee was appointed
to review the situation. This Committee, which consisted of five mem-
bers and included Surgeon Rear-Admiral R. A. Rowlands, as Chairman,
Professor Major Greenwood and Surgeon Commander J. A. Fraser
Roberts, was given wide terms of reference. It concluded that the
existing system in the Navy was inadequate to meet modern administra-
tive and scientific demands and that only a small portion of the informa-
tion available was in fact utilised in compiling naval medical statistics.
While appreciating that every effort had been made to compile medical
statistics under the system then in existence the Committee considered
that the time had come to make drastic changes and to recommend
the introduction of a new system and new statistical procedures at the
end of the war. At the same time it was suggested that steps be taken
immediately without radical changes in the existing system to permit
a better use of the records available and to initiate the task of their
analysis.

Matters which, in the opinion of the Committee, called for attention
were lack of expert statistical guidance, lack of administrative co-

9

1o CASUALTIES AND MEDICAL STATISTICS

ordination and lack of sufficient clerical staff. The Committee was
aware of the difficulties and was reluctant to make any recommendation
which would involve the employment of additional man-power for
statistical work. This was, perhaps, the most significant observation for
the problem of man-power was one which had become vital to the
maintenance of naval medical statistics at this particular time. Without
adequate clerical assistance the work could not proceed.

The Committee presented its report towards the end of 1943. Its
recommendations were approved in principle, but it proved impossible
to take immediate steps towards implementing them all, as it was the
general policy of all Government Departments that no task should be
undertaken which was not essential to the successful prosecution of the
war. This work was not considered to be essential.

At the end of the war in November 1945, a further Committee was
appointed with the following terms of reference:

(1) To prepare a scheme for the future organisation of the medical
statistical services for the Royal Navy and to make recommenda-
tions regarding its implementation.

(2) To make proposals on the number and qualifications required for
the statistical staff in the Department of the Medical Director-
General for the satisfactory operation of the new scheme.

(3) To consider the administration and non-statistical consequences
likely to be involved in the adoption of the new scheme and to
recommend accordingly.

This Committee completed its investigations and presented its final
report in July 1946 and came to be known as the Royal Naval Medical
Statistics Committee, 1946. Its detailed recommendations were:

(1) That a statistical and research file should be set up comprising an
individual record for each officer and rating in the Navy.

(2) That such a file should be a current one so that should an officer
or rating leave the Navy his medical records would be transferred
to a ‘dead’ file.

(3) That such a statistical and research file could not form part of the
more ample records required for administrative purposes.

(4) That the statistical and research file should not contain any informa-
tion not included in the administrative records.

(5) That the statistical and research file should include:

(a) General personal particulars of each individual on entry into
the Navy which would periodically be kept up to date.
(b) Medical particulars of each individual at the time of entry.

THE ROYAL NAVAL MEDICAL SERVICES 11

(c) Records of sickness.

(d) Additional medical information, such as records of routine
medical examinations, the results of routine chest X-rays,
records of inoculations and vaccinations, etc.

(e) A record of the movements of an individual from ship to ship
during the course of his Service career.

(6) That a card recording as much of the information as practicable
should form part of the statistical and research file.

(7) That the statistical and research file should be linked to one or
more punched card indexes.

(8) The complete revision of medical history documents to ensure
that copies of records of sickness of the individual accompany
him throughout his Service career and are made available to
the Medical Officer.

(9) Central control, in the Department of the Medical Director-
General, of the complete medical statistical data of the whole of
naval personnel, through which it would become possible to
acquaint the Board of Admiralty and the public with facts relating
to the health of the Navy far more fully and quickly than had been
possible in the past (once the system was running satisfactorily).

(10) That new measures would call for adequate trained staff to work
the new statistical machine.

Most of these recommendations of the ‘1946 Committee’, in addition
to a number of others, were fully implemented and co-ordinated with
the post-war reorganisation of the medical records and statistical
departments of the Army and the Royal Air Force. But, although great
progress was thus made in reorganising the basic system for compiling
naval medical statistics for the future, the Committee had not yet
closed the gap which existed in the naval medical records of the past,
and particularly for that period covered by the Second World War.
The existence of this gap meant that even as late as 1948 those who
were responsible for the production of the Official Naval History of the
War were unable to produce any official figures. In November 1948,
this subject was discussed by the Medical Director-General of the Navy,
Surgeon Vice-Admiral Sir Henry St. Clair Colson, and the Senior Civil
Consulting Physician to the Navy, Sir Alun Rowlands (previously
Surgeon Rear-Admiral R. A. Rowlands) who had been closely associated
with the activities of the 1943 and 1946 Committees. The chief points
established by this discussion were as follows:

(1) It was essential for the production of the Official Naval Medical
History of the War that certain naval medical statistics should be
compiled and made available as soon as possible.

12 CASUALTIES AND MEDICAL STATISTICS

(2) It was agreed that work upon naval medical statistics as a whole
should be recommenced immediately to cover the war period.

(3) It was felt that the production of a complete ‘Report on the Health
of the Navy’ as previously published would not be necessary for
the purposes of the Official History. Instead, it was considered
that a tabular statement should be compiled to show:

(a) The total number of cases according to sickness and injury.

(b) The total number of final invalidings.

(c) The total number of deaths.

(d) The total number of days sickness on board ship and in hospital-

(e) The average number of persons sick daily.

(f) The ratio per 1,000 of total force sick daily.

(g) The ratio per 1,000 of total force of (a), (b) and (c) above. The
whole of the above tabular statement was to be classified in
accordance with the nomenclature of diseases as set out in the
nosological tables in the journals of medical officers.

(4) It was also agreed that a serving medical officer on the staff of the
Medical Director-General should act in a consulting capacity
while the work was being carried out.

As a result a tabular statement was compiled for the war years in the
Medical Department, Admiralty, under the supervision of Mr. W. G.
Grant, which was based on figures from 20,537 medical officers’
journals. The work of abstracting the information for the years 1939-45
was thus deferred until 1948. The figures which were made available
eventually are contained in Tables 4-10. Condensed versions of these
tables were published and discussed in the Journal of the Royal Naval
Medical Service in 1966.3 They provide the most accurate record
available of the causes of man-power wastage due to sickness and injury
in the Total Force during the years of the Second World War. It was
only after the war that statistical reports were prepared which allowed a
comparison to be made between the overall case incidence of the men
in the Navy and that of the Women’s Royal Naval Service.

The only action to compile vital statistics for the Total Force during
the course of hostilities was the completion by Dr. (then Surgeon
Commander) J. A. Fraser Roberts of an ‘Analysis of Invalidings due
to Disease and Deaths due to Disease for the years 1934-43’ which
was afforded only a limited circulation as an Admiralty Book of Refer-
ence.* This is reproduced in Section II. The figures for officers are
excluded from most of the tables and the invaliding and death rates
for certain diseases therefore vary from the rates for the Total Force

* Admiralty Book of Reference 1235 (1944).

THE ROYAL NAVAL MEDICAL SERVICES 13

which are shown in Tables 4-10 which are the rates for ratings and
officers combined. Within the limitations imposed by war-time security
and the lack of adequate statistical machinery this report, which has
remained buried in the archives until recently, provided for the first
time reliable figures for major diseases of officers and ratings separately
and for the women as well as the men who served in the Navy. Fraser
Roberts also showed the importance of adjusting the crude rates for
diseases to allow for the different distributions of the age groups in the
peace-time and war-time navies. In the words of Professor Major
Greenwood, F.R.s., a member of the 1943 and 1946 Committees on
Medical Statistics who wrote the Foreword, it attained ‘a scientific
standard which would justify its publication in the transactions of any
learned society’. It is complete and provides the only uninterrupted
account of disease trends in the Navy for the years preceding the
Second World War and during the first four years of the war. The
figures for invalidings in 1944 which are shown in Tables 11-23 and.
29 were added after the book was published.

A comprehensive register of all cases admitted to the Royal Naval
Hospital, Haslar, the largest British naval hospital, during the years
1939 to 1945, with the final diagnoses in each case, was maintained
throughout the war by the Senior Consultant in Medicine, Surgeon
Rear-Admiral R. A. (later Sir Alun) Rowlands. Sir Alun also arranged
for the abstraction of similar information from the Hospital Muster
Books for the years 1914-18 inclusive which provides the only valid
comparison which can be made of the patterns of disease at a home-
based naval hospital during the two wars.? The case numbers and the
cases per 1,000 admissions are tabulated in Tables 33-38 according to
a nosological index based on Table 3 of the Medical Officers’ Journal.

14 CASUALTIES AND MEDICAL STATISTICS

I. THE TOTAL FORCE

In Table 1 the broad picture during the Second World War is
compared with that for 1936,‘ the last year for which the Report on the
Health of the Navy compiled by the old system was published, and
1953,° the first post-war year for which the Report was compiled by a
new system of centralised medical recording with machine analysis of
the coded data.

TABLE 1
Morbidity, Invaliding and Mortality Rates for Diseases and Injuries
Sor the years 1936, 1939-45 and 1953 (excluding casualties in action)

Fresh Cases Sick Daily per | Final Invalidings | Deaths per 1,000

per 1,000 1,000 Strength per 1,000 Strength
Strength (non-effective Strength
rate)

1936 437 19°5 20
1939 504 19°9 46
1940 473 19°3 32
1941 434 181 32
1942 409 172 29
1943 412 152 34
1944 361 Ist 2:8
1945 377 16-1 2°6
1953 378 15°6 "7

During the war years the Navy expanded greatly. The age, constitu-
tion and the general physical status of its personnel were influenced and
these changes affected the rates of sickness and death. With this proviso
(excluding all casualties in action) the Navy would not appear to have
been much less healthy in war-time than in these two years of peace.
In fact it would appear that, except for deaths, in war the health of the
Navy compared favourably with that during the years 1936 and 1953.

In Table 2 a comparison is made for certain of the more prominent
disease groups. The sickness rates for 1953 are not included as the
diseases included under these headings in the World Health Organisa-
tion’s nomenclature which was adopted in 1953 and the succeeding
years differ from those included under similar headings in the previous
Reports. The incidence for different diseases is shown separately for
officers and ratings and the total case incidence is not usually given in
the reports prepared after the war.

Venereal disease rates were considerably reduced compared with the
rate in 1936 partly as a result of advances in chemotherapy, partly
because of extended spells of service at sea with less leave in foreign
ports and partly because urethritis non-venereal, the incidence of which
increased during the war, was shown not under venereal diseases but

THE ROYAL NAVAL MEDICAL SERVICES 15

TABLE 2
Common Disease Groups for Officers and Ratings
Rates per 1,000. 1936, 1939-45

Disease 1936 | 1939 1941 1944 | 1945
Venereal Disease 56°6 : 33°70 . 7 226 | 317
Malaria y 24 6 63 76 gs.
Diseases of the Eye G 44 : 40 29 33
Diseases of the Ear ; 94 7 68 7 . 59 88
Diseases of the Veins . 21 7 24 . 27 35
Diseases of the Stomach

and Duodenum 7 16°8 F 7 . 158 | 1778
Diseases of the
Generative System and

of Urinary Organs 120 | 14°6
Appendicitis 44 42
Hernia 34 36
Injuries 44 | 4071
Diseases of the Liver 36 38

under diseases of the urinary and generative systems although most of
these infections were acquired as the result of sexual intercourse.

By 1943 there had been nearly a five-fold increase in the rate of malaria.
The war-time rates for diseases of the stomach and duodenum increased
above the peace-time rate, but the surprising fact is that the overall
picture in war-time did not change very greatly so far as one can discern
from these gross statistics.

The increase in diseases of the liver was almost entirely due to the
increased incidence of hepatitis. With the swollen war-time population
and the long periods of convalescence frequently necessary, the actual
demands on hospitals for beds for cases of hepatitis were greater than is
suggested by the increase in rates in 1943 and 1944 shown above.
Reference to Table 8 shows that the ratio per 1,000 ‘sick daily’ with
diseases of the liver of 0-29 per 1,000 in 1943 was only exceeded for
injuries and the respiratory tract infections, pulmonary tuberculosis,
the common cold, bronchitis and tonsillitis.

In Table 3 the invaliding rates for 1936 and 1953 are shown to
illustrate the wastage sustained in this way before and after the war
together with the losses during the war by reference to four of the most
Prominent causes of ill-health—pulmonary tuberculosis, psycho-
neurotic illness, peptic ulcer and diseases of the eye.

There was a considerable increase in the invaliding rate for psycho-
neurotic disease during the war. The invaliding rate for pulmonary
tuberculosis showed a slight increase but this was primarily the result
of the introduction of mass fluorography and more careful discrimina-
tion in eliminating those with early active infections from the Service.
The incidence of disease detected clinically was declining during these
years, a steady decline which, as Brooks® has reported, eventually

16 CASUALTIES AND MEDICAL STATISTICS

TABLE 3

Invalidings—Respiratory Tuberculosis, Psychoneuroses and
Psychoses, Peptic Ulcer, Diseases of the Eye. Rates per 1,000

Respiratory Psychoneuroses, Peptic Diseases

Tuberculosis Psychoses, etc. Ulcer of Eye
1936 rg Vs os Vr
1939 r6 23 v2 o9
1940 V7 42 16 ro
1941 21 57 27 ro
1942 26 35 7 o6
1943 25 33 r4 o4
1944 24 3°6 2 o4
1945 24 54 29 ro
1953 25 28 23 Vr

resulted in a marked reduction of ‘clinical’ pulmonary tuberculosis
between the years 1939 and 1953.

The invaliding rate for peptic ulcer was considerably in excess of the
pre-war rate. A high rate was still maintained in 1953, eight years after
the end of the war. It is not possible to say whether the increased
invaliding rates for psychiatric disease and peptic ulcer were due to a
real increase in disease or to revised medical standards. Perhaps the
average pre-war man accepted more in the way of dyspepsia as a matter
of course than the post-war individual without allowing it to disrupt his
life and his work; perhaps the naval authorities were less inclined to
retain the chronic dyspeptic than before the war. Undoubtedly many
factors played their part.

17

THE ROYAL NAVAL MEDICAL SERVICES

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THE ROYAL NAVAL MEDICAL SERVICES

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28 CASUALTIES AND MEDICAL STATISTICS

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THE ROYAL NAVAL MEDICAL SERVICES

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36 CASUALTIES AND MEDICAL STATISTICS

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THE ROYAL NAVAL MEDICAL SERVICES

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48 CASUALTIES AND MEDICAL STATISTICS

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52 CASUALTIES AND MEDICAL STATISTICS

II. INVALIDINGS DUE TO DISEASE AND DEATHS
DUE TO DISEASE

Some time after the first draft of Section I—Total Force—was
prepared the following masterly analysis of invalidings due to disease
and deaths due to disease in the Royal Navy for the years 1934-1943
(1944 added later), which had been completed by Surgeon Commander
J. A. Fraser Roberts, R.N.V.R., when he was on the Staff of the Medical
Director-General during the war, and which had formerly been a
Restricted Document, was declassified. This made it possible to include
this notable milestone in Naval medical statistics in toto in this contri-
bution, preceded by a Foreword by the late Professor Major Greenwood,
F.R.S., Consultant in Medical Statistics to the Royal Navy during the
war years.

FOREWORD
by
Major Greenwood, F.R.S., D.Sc., F.R.C.P.

It has been suggested that, as civilian consultant to the Board of
Admiralty and a member of the Committee which advised an immediate
analysis of available statistical data of mortality and invaliding rates
from disease, I might appropriately submit to you some general
observations on the following report.

In the first place, I wish to say emphatically that this report reflects
the greatest credit on those members of your Headquarters staff who,
under conditions of great difficulty, have produced a document which
attains a scientific standard which would justify its publication in the
transactions of any learned society. Further, I would say that the
inferences drawn by the compiler are of practical importance to the
Board, for they not only set out the causes and numerical importance of
wastage down to the end of 1943, but permit reasonable forecasts to
be made under service conditions of the future.

The inferences in the report are so clearly stated that it may seem
superfluous to say more, but I may perhaps underline those conclusions
which are of particular interest to executive officers. From the point of
view of Service wastage, rates of invaliding out and of dying have the
same effect, they can be added together. Taking the gross figures, viz.,
rates not adjusted to age composition, there is no change in death rates
when pre-war and war-time figures are compared; roughly, the death
rates were about 1-1 per 1,000 immediately before and during the war.
The invaliding rate increased from a little more than 12-0 per 1,000 to
between 17 and 18 per 1,000. The total wastage rate, therefore, increased

THE ROYAL NAVAL MEDICAL SERVICES 53

by about 45 per cent. As a matter of merely archaeological interest, I
infer that the death rate in Nelson’s fleet in the two years August 1803,
to August 1805, which Gillespie (rightly) contrasted with earlier fleet
experience as a triumph of sanitary organisation, was about five times
that of naval ratings in 1940-43.

If we used the crude wastage rate as a measure of the intake needed
to compensate for wastage from disease, the result would be of little
value because of changes in the age composition of the fleet and of the
wholly different wastage rates in age groups. The figures shown in
Table 11 for age groups are those needed and it will be seen that in all
groups of age above 20 those of 1943 show improvement, although the
rates at ages over 30 continue greatly in excess of pre-war rates. It is,
however, evident that even in the highest age group, ratings over 39
years of age, wastage is not calamitous; for, adding invaliding to
mortality rates, we have a round figure of 34:0 per 1,000; a group
suffering this annual wastage would not be reduced to go per cent. of its
original strength in less than three years. These data provide a wholly
adequate picture of the general position, but what in civilian statistics
would be called an occupational analysis would be needed to inform the
executive officer of the amount of important variation. It is obvious that
the strain imposed on the crew of a submarine or upon fleet air arm
pilots may be much greater than upon ratings employed in office work
ashore. But, even if Service conditions permitted such an analysis, its
immediate value for practical purposes might be small. Even the war-time
Navy is not, statistically speaking, a very large aggregate. If occupation-
ally subdivided not merely into arms of the Service, but further into
occupational groups within each arm, the resultant special wastage rates
would often be based on such small numbers that their reliability
would be small.

In the past this fundamental principle has often been violated in
Service publications which have included hundreds of rates based upon
figures so small that no thoughtful person would trust them as measures
of Service conditions. This, of course, does not mean that a naval
statistician is to refuse to advise an executive officer on the inferences to
be drawn from a statistical statement unless the data are reckoned in
thousands; he would indeed be an unprofitable public servant if he
took that course. One can easily imagine Service problems (such, for
instance, as those which are on the borderline between medicine and
training) of great importance for the study of which large numbers
could not be available. Modern statistical methods enable us to draw
conclusions from samples which a generation ago would have been
regarded as hopelessly inadequate. But these methods do not lend
themselves to brief statement or expression in simple averages intelligible
to a hasty reader. To reach these one must have large numbers.

54 CASUALTIES AND MEDICAL STATISTICS

The reasons just given explain the restrictions of analysis by causes
of wastage to a small number of groups. For rapid comparison the age
adjusted rates of Table 12 should be used. An executive officer will
naturally look at the items of greatest numerical importance, which are
Pulmonary Tuberculosis, Psychoses, etc., and Peptic Ulcer. In 1934-38
these three causes accounted for about 35 per cent. of the whole invalid-
ing rate (age adjusted); in 1942 they accounted for more than half the
total. The compiler’s comments should be noted. I merely remark that
here we have a striking example of the influence on bodily health of
psychological factors. Pulmonary Tuberculosis is affected, as the com-
piler points out, by special factors, viz., new methods of ascertainment;
even here, however, mental strain is not irrelevant. The connexion
between the other two groups—a connexion, not, of course, an identity—
is manifest. Once again the importance of personnel selection is
indicated.

For, I think, the first time some comparison has been instituted
between the experience of officers and ratings. For reasons stated in the
report, this can only be rough, but is suggestive. The proportion borne
by the three above-named groups of the total invaliding rate has changed
less between 1934-38 and 1942 than among ratings; but age standardisa-
tion might greatly modify this impression. These are, I think, some of
the most interesting points made. This is not the place to discuss a
general reform of record taking, which was the subject-matter of
Surgeon Rear Admiral Rowlands’s committee’s recent report. I hope,
however, that enough has been said to satisfy the Board that further
analysis of existing data would be of value in war-timeand that co-opera-
tion between other branches (especially those concerned with wastage
during or immediately after training) and your medical-statistical staff
is desirable.

THE ROYAL NAVAL MEDICAL SERVICES 55

RN.

An Analysis of Invalidings due to Disease
and Deaths due to Disease, 1934-1944

by Surgeon Commander J. A. Fraser Roberts, R.N.V.R.

GENERAL SUMMARY

1. The tables show invalidings due to disease and deaths due to
disease as annual rates per 1,000 strength borne, of officers or of ratings
respectively, for each of the war years 1939 to 1943. They also show, for
comparison, the corresponding average annual rates for the five-year
period, 1934-38, immediately preceding the war.

2. The tables are themselves the summary of this enquiry.—It is
impossible to do more in this general summary than direct attention to
some of the more important values and trends.

3. The danger of comparing the invaliding rates of peace and war.—
Table 11 shows that the average annual invaliding rate among ratings
for the period 1934-38 was 10-4 per 1,000. This is not greatly different
from the figure of 12:8 in 1943; yet when examined age group by age
group they are seen to be very differently made up. In peace-time there
is a wide margin for selection and the emphasis is upon the early
elimination of those unlikely to stay the course. Therefore the invaliding
rate for those under 20 is no less than 16-3 per 1,000; with the further
consequence of a fall to 5-9 by the time the age of 30-34 is attained.

In war-time, once a man has commenced his service, all the emphasis
is upon keeping him at duty as long as possible. The true biological
relationship then emerges: the older the man the smaller his chances of
remaining fit. In 1943 the invaliding rate rose steadily from 9-4 per 1,000
in the under-twenties to 30-3 in the over-forties.

Thus, although the total rates for all ages are so similar in the two
periods, the pre-war rate is nearly 75 per cent. greater for those under
20, while the war-time rate is nearly 300 per cent. greater among the
over-forties.

With this caution, the comparison with pre-war rates is useful for
some purposes, e.g., in connexion with pulmonary tuberculosis.

4. The magnitude of differences in invaliding rates at different ages.—
Some diseases show little change with age, e.g., pulmonary tuberculosis
(Table 13); in others it is very great. In circulatory diseases, for example,
the rate at advanced ages may be anything up to 20 times what it is
among the young.

56 CASUALTIES AND MEDICAL STATISTICS

The effect on total figures has been indicated in paragraph 3 above.
The problem of wastage caused by invalidings due to disease cannot be
properly investigated without taking age into account.

5. The importance of studying rates adjusted so as to allow for changes
in the age structure of the Service—It follows from what has been said
that changes in the age composition of the Service could easily lead to
wide variations in invaliding rates without any marked change when
corresponding age groups are compared. Consequently the tables
showing invaliding rates give both crude and age-adjusted rates. The
latter are simply the rates that would have been observed had the age
composition of the Navy remained constant at the average figure for the
period 1934-38.

Two important and opposed trends have affected the age composition
of the Royal Navy during the war. First, the intake of reservists in
1939-40 brought in a group which, though not very large numerically
compared with the whole force, nevertheless had such a high invaliding
rate that age-adjusted rates for these years are substantially lower than
the crude rates (see Table 11). Thereafter this effect diminished, while
the great intake of the very young has produced the opposite effect.
By 1942 the age-adjusted rate is appreciably higher than the crude rate.

Table 18 (circulatory diseases) illustrates the most extreme effects of
age adjustment.

6. The general trend of invaliding rates throughout the war.—The total
figures (Table 11) show that the rate rose to a peak in 1941 and
thereafter declined.

Taking the age groups separately, however, it is noteworthy that the
peak was attained in 1941 among those under 35, there was little
difference between 1940 and 1941 at 35-39, while among those over 39
the peak occurred in 1940, not in 1941. These tendencies appear in
some of the tables showing individual disease groups, very notably in the
case of mental diseases (Table 15). It is probably reasonable to deduce
that among younger men the highest invaliding rates correspond to the
period of maximum operational stress, whereas the older men, the
reservists of 1939-40, rapidly showed that a substantial proportion were
unable to stand the strain of any form of naval service.

The invaliding rate among officers (Tables 22 and 23 ) varied very
little throughout the war except for a very high figure in 1940. Un-
fortunately, age adjustment cannot be carried out on the figures for
officers. It is likely, however, that the peak (again specially notable in
mental diseases) is to be attributed to the cause mentioned in the
previous paragraph.

7. The closely parallel trend of mental diseases and peptic ulcer (Tables
15 and 20).—The trends are very similar throughout the period, except

THE ROYAL NAVAL MEDICAL SERVICES 57

that peptic ulcer does not show the marked peak in 1940 among older
men.

8. Death rates due to disease—In contrast to the invaliding rate, the
death rate due to disease has remained remarkably constant throughout
the whole period. In fact, when changes in the age composition of the
Service are allowed for, there is no significant variation. It can be
concluded that apart from fluctuations due simply to this cause and a
fall in deaths from pulmonary tuberculosis in 1943 the rate has not
varied throughout the war and is no higher in war than peace.

Officers have almost double the death rate of ratings. This is to be
attributed almost entirely, in all probability, to their greater age.
Greater reluctance to invalid officers is probably a contributory factor.
As mentioned above, however, age adjustments cannot be made; nor
can it be shown (as is probably the case) that fluctuations in the death
rate among officers, shown in Table 27, are to be attributed to varia-
tions in age composition of the officer population.

9. Pulmonary Tuberculosis—This requires a special word as the
trends are entirely different from those of any other disease group shown.
To take one comparison, in 1940 mental diseases were twice as important
as pulmonary tuberculosis as a cause of invaliding. In 1942-43 there is
little difference.

The invaliding rate among ratings (Table 13) remained constant till
1940. A sharp rise occurred in 1941 and a further sharp rise in 1942.
Among officers the rate of invaliding remained constant for a year
longer, the rise taking place in 1942.

A fall among ratings took place in 1943. On the relatively large
numbers involved this attains high significance when compared with the
rate for 1942. It will be interesting to see whether this favourable
tendency continued in 1944.* Over so short a period and on the basis
of these figures alone no definite statement can be made as to the
possible effect of miniature mass fluorography in bringing about the
fall. This much, however, can be said: a change in the hoped for
direction has taken place at the time at which it would have been
expected.

Officers have not shared the fall of 1943.

It is known in civilian practice and confirmed in these tables that age
adjustment has little effect on figures for pulmonary tuberculosis.
Hence it is reasonable to compare the absolute rates of officers and
ratings. The rate among officers is only half what it is among ratings,
the same proportionate rise having taken place in both during the
war.

* Reference to Table 13, however, shows that this was not the case. (Ed.)

58 CASUALTIES AND MEDICAL STATISTICS

The death rate from tuberculosis (Table 25) among ratings remained
constant till 1943, when it fell almost to half. It is difficult not to con-
clude that this is the direct result of mass fluorography, which has led
to the earlier detection and invaliding of those who otherwise would
have died while still in the Service.

The figures for officers are too small to support any conclusion.

THE ROYAL NAVAL MEDICAL SERVICES 59
GENERAL NOTES ON TABLES 11-32

1. Population concerned.—Those classes of Royal Navy and Royal
Marine personnel have been included which were similarly included in
‘The Health of the Navy’, last published in 1936.

2. Choice of disease groups.—It is impossible to discern trends and
detect changes unless numbers are sufficient. This severely limits the
number of disease groups which it is profitable to show separately.
The choice of disease groups has been largely determined by this, but a
number of other factors were also borne in mind: first, that the disease
groups should be reasonably homogeneous; secondly, that they should
be separable from one another with fair efficiency; thirdly, that any
separation should be likely to have some practical importance; lastly,
that as it might be desired to condense the list further, additional
groups, not themselves important, would be needed to ensure complete-
ness.

Invalidings due to disease have been classified under 17 headings;
deaths, owing to the smaller numbers involved, under 6.

3. Basis of classification into disease group.—The classification used to
determine the group into which invalidings and deaths fell was the
Medical Research Council Morbidity Code (1944). One departure, not
numerically important, was, however, made. In the Code deformities
resulting from injury are classified as disease not injury. It is easy to see
why this should be done in civilian practice. In a fighting Service,
however, the great majority of injuries producing subsequent deformity
have been incurred in the Service; hence it seemed preferable to classify
the resulting disability as due to injury and these cases do not appear in
the analysis.

4. The significance of a difference between two rates—When the rates
for two periods differ it is important to know whether the difference
could have arisen simply by chance, i.e., owing to the accidents of
sampling, or whether this is unlikely. If the former there is nothing to
discuss; if the latter it is permissible to speculate on possible causes for
the change.

The logic of the procedure adopted in the tables showing invaliding
rates is as follows. In comparing the rates for two periods one inquires
how often from a population showing the joint pooled rate of the two
periods one could expect to draw samples of the sizes concerned which
differ by at least the amount observed. Arbitrary levels must then be
selected. If the difference could arise by chance in this way more often
than once in 20 times it is judged non-significant, for it could so easily
have arisen by the accidents of sampling that any further discussion is

3*CMS

60 CASUALTIES AND MEDICAL STATISTICS

profitless. If, however, the observed difference would occur by chance
less often than once in 20 times it is becoming unlikely that it has arisen
in this way; there is something to explain. Such a difference is termed
significant in these tables. If the observed difference would occur by the
accidents of sampling less often than once in 100 times it is judged
highly unlikely to have arisen in this way and the difference is termed
highly significant.

The larger the numbers observed the smaller the change in rate that
we can detect. For example, the invaliding rate due to pulmonary
tuberculosis at all ages in 1942 was 2-93 per annum per 1,000 strength.
The corresponding rate in 1943 was 2:54. Because of the relatively large
numbers concerned, this fall, though moderate, is nevertheless highly
significant.

As a contrast in the age group 25-29 in 1939 the invaliding rate for
peptic ulcer was 0-53; in 1940 it was 1-05. Although the ratehasdoubled,
the difference, owing to the relatively small numbers involved, is not
significant. In the absence of additional evidence based on other years
and other age groups discussion would be a waste of time.

In the tables showing invaliding rates each figure is compared with
the corresponding figure for 1940, the first complete war year. A
significant difference is indicated by the sign +; a highly significant
difference by + +. (Thecomparison isbased on the ratioof the difference
to its standard error, the latter being calculated on the pooled rate.
This is equivalent to a 2 x 2 test for homogeneity. Yates’s correction for
continuity has been used. Where the expected number in either group
was less than 5, odds were calculated exactly.)

The death rates, owing to their greater constancy, lend themselves to
the direct question—has there been any significant variation at all?
The answer will be found in the notes appended to the tables.

61

THE ROYAL NAVAL MEDICAL SERVICES

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11 a1aV,L

CASUALTIES AND MEDICAL STATISTICS

62

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—40q ayi fo sasvasyy
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++ £8.0 ++ S£.0 ++ 29-0 Sg-0 00-1 £g-0 ++ ber sey epriy
akg ayy fo sasvasiq”
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(papnyaxgy $420) “yxBussag oo0'r 4ad sayvy yonuuyy ‘asvasiq, 04 anp sBurpyyvauy

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64 CASUALTIES AND MEDICAL STATISTICS

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66 CASUALTIES AND MEDICAL STATISTICS

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68 CASUALTIES AND MEDICAL STATISTICS

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THE ROYAL NAVAL MEDICAL SERVICES 69

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74 CASUALTIES AND MEDICAL STATISTICS

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76 CASUALTIES AND MEDICAL STATISTICS

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THE ROYAL NAVAL MEDICAL SERVICES 77

TABLE 27

Officers. Deaths due to Disease. Total Annual Rates per 1,000 Strength

Norges ON TABLE 27

1. Owing to the fact that ages of officers are often omitted in documents reaching the
Medical Department, age relationships cannot be investigated.

2. The rate among officers is only 30 per cent. higher than among ratings (Table 24)
during the peace-time period 1934-38.

3. During war-time the rate among officers is about double that of ratings. This is
chiefly due, in all probability, to the much larger proportion of older officers. This is
confirmed by the fact that over the whole period deaths due to circulatory disease, a
sensitive indicator of age, are nearly four times more frequent among officers. A
contributory cause may be the greater reluctance to invalid officers.

4. The annual death rates for officers are markedly variable, with a peak in 1940.
This, too, may well be due to changes in the age composition of the officer population

TABLE 28
Officers. Deaths due to Disease for the Whole Period 1939-43. Annual Rates per 1,000
Strength by Disease Groups

Pulmonary Tuberculosis 2 . s : . 0°09
Diseases of the Nervous System i) + $ . O18
Diseases of the Circulatory System . ‘ - 0°57
Diseases of the Respiratory System . 3 3 ~ 0°24
Diseases of the Digestive System 2 0°30
Other Diseases ey 4 A 0°69

Total—All Diseases . ‘ ‘5 . ry . 2°07

Notes ON TABLE 28

1. The numbers involved are too small to show figures for the years separately.
2. The death rate from pulmonary tuberculosis is distinctly lower than among
ratings (see Table 26).

_3. In the other disease groups it is higher, being no less than four times as high in
Circulatory diseases.

W.R.N.S.
An Analysis of Invalidings due to Disease
and Deaths due to Disease, 1941-44

Nores ON THE TABLES

1. The general notes (pp. 59-60) refer to these tables also.

2. Age censuses are not available for officers and ratings separately. Consequently
the joint figures have had to be used for ratings. Officers are, of course, older, but as they
Constitute only 5 per cent. of the W.R.N.S., the calculation of age-adjusted rates would
not be seriously affected.

For the year 1941 only one age census, that of December 31, is available. This has
been applied to the whole year.

3. Table 29 shows that the total invaliding rate fell sharply from 1941 to 1942 and
that there is practically no difference between 1942 and 1943. The numbers borne,
Particularly in 1941, were small, so that hardly any of the differences in the rates for
individual disease groups are significant.

78 CASUALTIES AND MEDICAL STATISTICS

4. In Table 31 the rates are adjusted for both sexes to the same standard population.
In addition the rates for women are further adjusted to what they would have been had
the numbers borne in the three years respectively been in the same proportion as.
among the men.

The total invaliding rates do not differ substantially, though the rate for women is
highly significantly lower than for men.

Men show rates which are highly significantly greater than among women in pulmon-
ary tuberculosis, epilepsy, diseases of the eye, diseases of the ear, peptic ulcer and other
diseases of the digestive system. They are significantly higher in bronchitis, other
respiratory diseases and deformities.

Women are highly significantly higher in mental diseases and circulatory diseases
and significantly higher in non-pulmonary tuberculosis.

The most striking difference is peptic ulcer, with a rate 12 times greater in men than
women.

TABLE 29
W.R.N.S. Invalidings due to Disease. Annual Rates per 1,000 Strength. (Officers
Excluded)
1941 1942 1943 1944

Tuberculosis, Pulmonary

Crude Rate : . . 1°94 1°65 1-82 1:77

Age Adjusted Rate | ¢ i 2-21 ral 1-76 1°51
Tuberculosis, Non-Pulmonary

Crude Rate. . . . 0-20 0°49 e133 0°27

Age Adjusted Rate . . : 0-22 0-45 0-2 0°27
Epil

Crude Rate. . . . O°74 0°39 Orn7 0°34

Age Adjusted Rate : Zi ‘ or 0-31 ons 0°27
Psychoses, Psychoneurosesand Mental

Deficiency

Crude Rate ‘ ‘ . sa: 4°28 4°26 4:98

Age Adjusted Rate : * . £433 4°27 4°72 “46 ++
Diseases of the Cwreilavery. System

Crude Rate. 0°94 1°05 O74 pee) at

Age Adjusted Rate . § ‘ 0-92 1-05 0-92 0-56 +
Diseases oj the Respiratory Swen,

Crude i * 1°34 o-8r °'79 1-Or

Age “Adjusted Rate . é . i422 + 0°73 1°03 O04
Diseases of the Digestive Syne

Crude Rate. . : O°54 0-32 o-ar 0°53

Age Adjusted Rate . '. % O's4 0:37 0-42 0-61
Diseases of the Locomotory System

Crude Rate. 1°41 o-74 0-58 o'8:

Age Adjusted Rate . ri < 1°37 0-77 0-70 o-98
Menopause

Crude Rate . a rt ‘ O47 0°42 0°46 0°43

Age Adjusted Rate . * . 0°37 0-29 0°42 0°56
Other Gynaecological Dustates

Crude Rai ‘ . rg 0°63 Bay oss

Age ‘Adjusted Rate | . i 1°23 0°64 °o: oor
Other Diseases

Crude Rate. $ . . 4°02 2°98 2:60 2:24 +

Age Adjusted Rate . . . 4°26 + 2-91 2-84 2°45
ToTaL—All Diseases

Crude Rate. ¥ . . 18-17 ++ 13°76 12°33 13°36

Age Adjusted Rate . * ¥ 18-73 ++ 13°20 13°70 1s7s2 ++

+ indicates ificant difference from the rate for 1942.

++ indicates a highly significant difference from the rate for 1942.

THE ROYAL NAVAL MEDICAL SERVICES’ 79

TABLE 30

W.R.N.S. Invalidings due to Disease, 1941-43, by Age Groups, Rates per 1,000 Strength

(Officers Excluded)

Under20 .
20-24

25-29
30-34.
35-39 - .
Over 39 .

TABLE 31

8-66

- 10°83
+ 13°42

15°22

+ 17°05
+ 47°50

R.N. Comparisons of Men and Women in regard to Invalidings due to Disease, 1941-43.
Annual Rates per 1,000 Strength. Figures adjusted for Age and Relative Proportions in
the Three Years. (Officers Excluded).

Women Men Bey a
Difference

Tuberculosis, Pulmonary 1°76 2-62 ++
Tuberculosis, Non-Pulmonary o-3r org +
Epilepsy 0°34 °°s9 ++
‘Other Diseases of the Nervous System 0°33 o-3r ca
Psychoses, Psychoneuroses and Mental Deficiency . 4°76 3-75 ++
Diseases of the Eve 0°23 o's8 ++
Diseases of the Ear : or13 0-77 ++
Diseases of the Circulatory System 0°96 oss ++
Bronchitis 0°40 o-6r +
Asthma. 0°30 0-25 =
Other Diseases of the Respiratory System 0°33 O52 +
Peptic Ulcer 0-17 2°20 ++
Other Diseases of the Digestive System 0°26 o-st ++
Arthritis. 0°32 0740 -
Deformities and Malformations of the Locomotory System o-2s 0°40 +
‘Other Diseases of the Locomotory System 0°32 0°40 -
Menopause 2. 0°36
‘Other Gynaecological Diseases 0-72 - =
OtherDiveases. | wwe 2°53 1°36 ++

TotaL—All Diseases i; ; ‘ a 2 ‘ 14°78 16-01 ++
A AR et re ee Ra a eel ea eee ee

TABLE 32
W.R.N.S. Deaths due to Disease, 1941-43. Annual Rates per 1,000 Strength
(Officers Excluded)
Crude Rate . 2 Zs 2

Age Adjusted Rate

Corresponding Age Adjusted Rate for Men

(Difference between sexes is highly significant)

80 CASUALTIES AND MEDICAL STATISTICS
III THE ROYAL NAVAL HOSPITAL, HASLAR

The numbers of patients admitted with different diseases or injuries
to the Royal Naval Hospital, Haslar, from 1914 to 1918 were obtained
from the Hospital Muster Books for those years and the numbers
admitted from 1939 to 1945 were recorded according to a nosological
index based on Table 3 of the Medical Officers’ Journal. They are
shown in Table 38. The proportions of each type of case per 1,000 total
admissions provide a contrast in this hospital’s experience in the two
wars and add to knowledge of the distribution of diseases (particularly
as from 1916 to 1918 there are otherwise no naval statistical data available,
as far as we are aware). The Statistical Reports of the Health of the
Navy for the years 1914 and 19157° published retrospectively after the
First World War provide a further basis for comparison for some
diseases.

This was the largest Naval hospital in both wars and the main clearing
station for cases invalided from abroad. The total numbers admitted are
shown in Table 33.

TABLE 33
Total Admissions to the Royal Naval Hospital, Haslar, in the First and Second World
‘ars
1939-45 ;
1914-18 (bed complement = 1,100 at times
(bed complement = 1,300) reduced to 400)
1914 (5 months) % ~ 1,362 1939 @ months) Re = 2,715
191s. z é - 11,306 1940 ‘ é + 12,491
1916. 5 ‘ + 13,169 1941. ve AS % - 13,688
1917. < J . + 14,956 1942. 2 Si ‘| - 15,823
1918, , ae “ - 14,149 1943 - “i 7 - 16,163
1944. 4 5 : ~ 14,382
1945. A i ‘ + 16,399
Total 54,942 Total 91,661

|

The numbers were consistently greater during the Second World
War than the First, which is somewhat surprising in view of the lower—
and during the air-raid years very much lower—bed complement; but
the turnover of cases was brisker in the Second World War because of
an effective arrangement for evacuating cases to Emergency Medical
Services Hospitals. The cases per thousand admissions for the more
prominent groups of diseases and injuries are given in Table 34.

These figures, being proportions of the total admissions, indicate
differences in the disease patterns at this hospital. They should not
be confused with incidence rates in the population at risk.

THE ROYAL NAVAL MEDICAL SERVICES 81

TABLE 34

Admissions to the Royal Naval Hospital, Haslar, during the First and Second World Wars
Proportion of cases per 1,000 admissions in certain disease groups.

1914-18 1939-45
Chicken Pox . Z 3 < a co o-9 2°6
Common Cold . a 2 « . * a 16°3 45°7
Dysentery . : F z . e - ‘ 22°6 24
Typhoid 5 ‘ t a is : 1 A 14°0 oz
Paratyphoid . ‘ 2 ‘ ‘ é : 7 225 o'2
Influenza. 3 3 ‘. 7 ‘ ; . 35°3 1-2
Malaria : ‘ * ‘ . 4 ‘ 7 9°9 3°3
Measles é 5 3 3 3 : i 7 16:0 2°9
Meningococcal Infection ; c 2 . : 4°72 18
Pneumococcal Infection (lungs) 3 : 5 s 17°4 11°7
Rheumatic Fever . : ‘ . ‘ E é 4°9 44
Rheumatism, sub-acute 5 2 ‘ ‘ : 1*4 3°0
Rubella : “ 5 $ ‘ é ‘ § 19°4 15°6
Tonsillitis . 5 , é : F ‘ : 14‘! 42°5
Tuberculosis—Pulmonary . ° . 19°2 25°2
Tuberculosis—Non-pulmonary : : ¢ . 2°3 2°6
Chancroid* . ; ‘ i 1Ie4 o's
Syphilis* : - ‘ : : : 1070 an3
Gonococcal Infection, Acute* : ‘ > i 33°6 76
Gonococcal Infection, Sequelae* . ‘ ‘ 11°6 273
Neurasthenia* y : a ‘ 3 i i 22°3 o4
Other Nervous Diseases (including Mental)* . ‘ 40°9 47°5
Diseases of the Heart (Organic) : 3 E : 19°0 4°5
Diseases of the Heart (Functional) . : : i 7:2 4°9
Bronchitis ‘ ‘ . : : a 15°5 24°8
Pleurisy . : i s i ‘ é 10°8 6-1
Appendicitis ; = r z " : 15°4 22°74
Peptic Ulcer (Gastric) . . x . . 7 2°5 9°7
Peptic Ulcer (Duodenal) "i 3 . f ‘ 21 21°3
Hernia c . 5 : ij : I e 28°7 34°0
Diseases of Muscles, Fasciae, etc. . z e : 21°5 1I‘r
Other Diseases of the Skin* . , i : 13°5 41°3
General Injuries. 4 as ‘ : 4 i 89°7 135°4
Injuries in Action . ‘ ‘ 2 ; é . 30°2 43°4

* See p. 82.

Whereas the proportion of illnesses designated as common cold and
tonsillitis in the Second World War was thrice that in the First, the
figure for influenza in the Second was only one thirtieth of that in the
First World War. ‘Catarrh’ was not a frequent diagnosis in this hospital
in the First World War in contrast with the Total Force figures for 1915
(the only year for which Total Force figures for ‘catarrh’ are available).

Prominent cause for the high influenza figure was undoubtedly the
epidemic in 1918 during which 1,942 cases were admitted. Naval
Personnel in the Port suffered lightly from influenza during the Second
World War—only in 1944 were there more than 20 admissions—but
the admission rate for the ‘common cold’ was always high, with a
Particularly heavy epidemic—1,533 admissions—in 1940.

82 CASUALTIES AND MEDICAL STATISTICS

A notable improvement was to be seen in the relative frequency of
dysentery in the Second World War which was one tenth of that in the
First.

The marked reduction in venereal disease at this hospital during the
Second World War was primarily due to the fact that most of these
cases were treated at another hospital in the Portsmouth area.

Similarly, the proportions of admissions for neurasthenia and mental
illness together were smaller in the Second World War when the more
serious cases in these categories were treated at the Royal Naval
Auxiliary Hospital, Knowle, not at Haslar.

Proportionately, ten times as many men were admitted with duodenal
ulcer during the Second as in the First World War partly because
opaque-meal examinations, which permitted a radiological diagnosis to
be made as a matter of routine in the Second World War, were not
carried out so frequently in the earlier war. It is possible that revised
medical standards and stress during the ‘blitzes’ were contributory
factors. Some indication of the latter is given in Table 35 by the peptic
ulcer admissions during 1941 when Portsmouth was heavily bombed
and in 1945 after the flying-bomb attacks and the invasion of Europe in
the previous year and this impression is reinforced by the invaliding
figures for digestive diseases for the Total Force.

TABLE 35
Peptic Ulcer admissions to the Royal Naval Hospital, Haslar

Total

Year | Admissions, | Gastric Ulcer Perforated Duodenal Perforated

All Causes Gastric Ulcer Ulcer Duodenal

Ulcer

1939 2,715 54 None None
1940 12,491 114 5 3
1941 13,688 184 30 19
1942 15,823 97 7 2
1943 16,163 112 15 13
1944 14,382 103 19 26
1945 16,399 223 48 24
Total 91,661 887 124

Proportionately, more patients with ‘diseases of the areolar tissue and
skin’ were treated at Haslar during the Second World War than in the
First. The cases under this heading per 1,000 total admissions are
summarised in Table 36. This may be partly because skin cases were
admitted more freely to hospital rather than because of a true increase
in skin disease, particularly as the rates for the Total Force were greater
for the years 1914 and 1915 than for the years 1939-45.

THE ROYAL NAVAL MEDICAL SERVICES 83

TABLE 36

Skin diseases. Cases per 1,000 admissions

1914-18 1939-45
Abscess . 3 z 78 6-4
Boil 3 *: a 273 4:0
Eczema . - . 3°9 o'8
Impetigo : A 13 6°5
Other Diseases ss 13°5 41-3

The larger proportion of ‘general injuries’ admitted during the
Second World War was due in part to the greater use of motor cycles and
other forms of motor vehicle, while the increased proportion of ‘injuries
in action’ were, perhaps, a natural result of the hospital being in the
‘front line’ more than it was in the First World War.

Table 37 below shows, for certain other diseases of topical interest,
the numbers of admissions to Haslar from 1939 to 1945 with the pro-
portions per 1,000 admissions and the rates per 1,000 strength of the
Portsmouth Command (excluding visiting ships).

TABLE 37
Diseases of topical interest at the Royal Naval Hospital, Haslar, 1939-45

Sroka Adinisad 1939 1940 1941 1942 1943 1944 1945 | Total
issions
2,715 | 12,491 | 13,688 | 15,823 | 16,163 | 14,382 | 16,399 | 91,661
Av. Complement Ports.
Command =. 21,177 | 20,625 | 36,223 | 48,634 | 66,451 | 91,641 | 70,641 | 364,392
Hypertension . 5 26 4 58 nm 78 714 gr
$(9-6) a {3} 4°5 1:3 &3 (5-6) ft: }
be (ar) (es 16) 15 1-2) (0-8) ay 1-2)
Catarthal or Toxic 37 70 7 185 89 186 652
Hepatitis : 3-3 370) {5:3} 478) ] (ures) 63} ary 7-1)
(0-4) 1-2) 1-9) 1°6) (28) 1-0. (2-6) 1-8)
Arvenical Hepatitis =. 1 57 106 100 so 17 336
& 4 8 (4-2) (6-7) (6-2 {3:3} (1-0) (3°77,
Cir) (0-2) (1-6) 2+2) (1-5 0°5) (0-2! (09
Glandular Fever : = 21 3: 2 a7 ay
S18 es Galen Seay en |e
- 1 0-2 (0-4) fo- : .
Carcinoma of Bronchus 1 4 3 H *y 3 2 3
emia < “é — — 3 I 2 2 s 13
Lymphadenoma 1 - 2 7 1 7 4 22
* Proportions per 1,000 admissions. **Rates per 1,000 strength.

The rates per 1,000 understate the true incidence since all cases in the
Command were not admitted to Haslar. They should be regarded rather
as indicators of the trend over the years. The average strengths are those
given in the Annual Reports of Naval Medical Officers of Health,
Portsmouth.

The increasing numbers of cases of hypertension during the first
four years of the war was due primarily to the increasing size of the
population at risk.

4cés

84 CASUALTIES AND MEDICAL STATISTICS

The increase in ‘catarrhal’ (or infective) hepatitis and ‘arsenical’
hepatitis during the early years of the war was real, although the latter
trend was reversed after 1942 when those responsible for the treatment
of syphilis became more aware of the dangers of transmitting the
hepatitis agent by contaminated syringes or needles. Evidence has been
provided to show that some cases of infective hepatitis in the Navy may
also have been due to ‘syringe-transmission’ as a result of routine
immunisation procedures.®-1° The admission rates for glandular fever
show a similar trend to those for hepatitis.

There were only 13 patients with carcinoma of the bronchus and
13 patients with leukaemia among 91,661 cases admitted to this hospital
but nearly twice as many were admitted with lymphadenoma.

In summary, the types of cases treated in the two wars differed in
several important respects, some of which are mentioned above. The
conditions under which the work was done were probably more rigorous
in the Second World War, particularly during the early years, when the
Port was under continuous threat of bombardment from the air and all
but the most seriously ill patients were evacuated to cots in the cellars
every night, while the hospital staff went to their action stations during
the fairly numerous air-raid alerts. It was, perhaps, surprising that most
of them, patients and staff, appeared to thrive under this routine.

85

THE ROYAL NAVAL MEDICAL SERVICES

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86 CASUALTIES AND MEDICAL STATISTICS

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THE ROYAL NAVAL MEDICAL SERVICES

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88 CASUALTIES AND MEDICAL STATISTICS

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THE ROYAL NAVAL MEDICAL SERVICES 8g

CONCLUSION

Apart from any other factor the disruption of the machinery for produc-
ing the Annual Reports on the Health of the Navy during the two
World Wars of the 2oth Century makes a retrospective comparison of
the causes of morbidity, invaliding and deaths in these two wars a
somewhat precarious undertaking. The figures for admissions to the
Royal Naval Hospital, Haslar, provide the only data which permit one
to contrast the pattern of diseases in the Navy throughout the two wars.
Those who wish to take the matter further might consult the numerous
Medical Officers’ Journals or the Death and Invaliding Registers for the
war years which are preserved in storage, but this would be a formidable
task. There are no intermediate records.

The deliberations of the war-time Committees on Naval Medical
Statistics were penetrating and exhaustive and their reports should be
consulted in the original by those who have to consider the Navy’s
needs in the future. For example, the 1946 Committee was well aware
that any report on the health of the Navy based on the nosological
tables of the Medical Officers’ Journals would be at least two years
behind the times by the time it was published and furthermore the
nosological tables and, therefore, the health of the Navy reports did not
include returns for those cases which were not placed on the sick list.
Thus, their Report stated:

‘Summary returns are essential to the work of the Statistics Branch
for they alone can provide prompt information on which immediate
action can be taken. They enable the Medical Director-General to
survey at any moment the health of the fleet and the availability of
accommodation for the sick. They have, however, another and most
important function, for they are capable of research uses which
cannot be met by detailed individual records. . . . A ship is a self-
contained community with a relatively stationary population. Hence
sickness rates can be readily worked out and related to such factors
as ship-design, climatic conditions and the like. . . . While the
individual records relate only to sickness sufficiently severe to
warrant the excuse of duty, summary returns can incorporate minor
sickness which, as it is ten times more frequent, is a far more sensitive
indicator of living conditions. . . . We would stress the fact that the
standard monthly sickness return can be, and most emphatically
should be, a simple document. Very few disease headings are needed
and when appropriate books for record-keeping and appropriate
forms are available, the rendering of accurate and valuable returns
should be a matter of the utmost simplicity. In this connection we
would recommend a census system of returns, i.e., the numbers in

go CASUALTIES AND MEDICAL STATISTICS

any category are counted at a fixed time each week . .. We recommend
that the returns should be made monthly in writing.’

It is significant that 1946 was the year when the first ENIAC computer
became available—a development which was eventually to make the
central management of such returns not only a more practical proposition
but also infinitely less liable to clerical inaccuracies—although this, of
course, does not diminish the clerical labour necessary on the periphery
to produce summary returns and the need for simplicity in the form of
the latter.

REFERENCES

. Hodge, W. V. (1855), J.R.Statist.Soc., 201 et seq.

. James, W., Naval History, 1822-1824.

. Ellis, F. P. and Rowlands, R. A. (1966), J. Roy.Nav.Med.Serv. 52, 5.

. Statistical Report of the Health of the Navy for the year 1936 (H.M.S.O.,
London).

. Statistical Report of the Health of the Navy for the years 1953-1956,

Admiralty Book of Reference (B.R.26(I), 1960).

Brooks, W. D. W. (1957), Lancet, i, 541.

. Statistical Report of the Health of the Navy for the year 1914 (H.M.S.O.,

London).

. Statistical Je of the Health of the Navy for the year 1915 (H.M.S.O.,
London).

g. Ellis, F. P. (1953), J.Hyg., Camb. 51, 145.

o. Ellis, F. P. (1955), J.Hyg., Camb. 53, 124.

PWN

oN

The Army Medical Services

MEDICAL STATISTICS
by Major H. G. Mayne

"cms

CONTENTS

LIST OF ABBREVIATIONS AND TERMS

INTRODUCTION

CHAP. I, UNITED KINGDOM

British Troops, Male, 1940-45
Tables 1-6. Admissions .
Table 7. Deaths

British Troops, Female, 1940-45
Tables 8-14. Admissions
Table 15. Deaths .

British Troops, Male, 1939
Table 16. Admissions

CHAP. II. FRANCE
British Troops, 1939-40
Tables 17-20. Admissions
Tables 21-22. Medical Evacuations to U. K.

CHAP. III. NORTH-WEST EUROPE
British Troops, 1944-45
Tables 23-27. Admissions

CHAP. IV. BRITISH NORTH AFRICAN AND CENTRAL

MEDITERRANEAN FORCES

Admissions
Tables 28-33. All Troops 1943-45 .
Tables 34-35. British Troops 1944 .
Tables 36-37. Canadian Troops 1944
Tables 38-39. New Zealand Troops 1944.
Tables 40-41. Indian Troops 1944 .
Tables 42-43. African Troops 1944.
Tables 44-45. British Troops 1945 .
Tables 46-47. Canadian Troops 1945
Tables 48-49 .New Zealand Troops 1945.
Tables 50-51. Indian Troops 1945 .
Tables 52-53. African Troops 1945.

CHAP. V. MIDDLE EAST FORCE .
Admissions
Table 54. All Troops 1941-45 ‘
Table 55. United Kingdom Troops 1939-45

93

107

148-156
157

159-167
- 168

226-231
232

237-246
247-249
250-252
253-255
256-258
259-261
262-264
265-266
267-268
269-270
271-272

273

280, 281
282, 283

94 CASUALTIES AND MEDICAL STATISTICS

Table 56. Dominion Troops 1942 . .
Table 57. South African Troops 1943-45 ‘ . <
Table 58. New Zealand Troops 1943-45 .

Table 59. Indian Troops 1941-45 :

Table 60. British African Troops 1943-45

Table 61. Other British Troops 1944-45 .

Table 62. Women’s Services 1942-45

Table 63. All Other Troops 1942-45

Tables 64-67. All Troops, by Commands 1942-45

Deaths
Table 68. All Troops 1941-45 5
Table 69. United Kingdom Troops 1941-45
Table 70. Indian Troops 1941-45
Table 71. Dominion Troops 1942 .
Tables 72~74. South African and New Zealand Troops | 1943- 45
Table 75. British African Troops 1943-45 .
Table 76. Other British Troops 1944-45 .
Table 77. Women’s Services 1942-45
Table 78. All Other Troops 1942-45 a
Tables 79-82. All Troops, by Commands 1942-. 45

CHAP. VI. WEST AFRICA
Admissions

Tables 83-89. Europeans and Africans 1941-45
Tables go-91. Medical Evacuations to U.K. and dInvalidings

1941-45
Deaths
Table 92. Europeans and Africans 1941-45

CHAP. VII. EAST AFRICA
Admissions and Deaths
Tables 93-94. All Troops 1944

Admissions
Table 95. British Troops 1945
Table 96. All Troops 1916-18, 1944

CHAP. VIII. INDIA

British Troops 1939-45
Table 97. Admissions
Table 98. Deaths .
Table 99. Invaliding . é
Table 100. Admissions, Deaths and ‘Invalids 1940-45
Table 101. Average Constantly Sick 1935-45

303

316-319

319, 320

321

322

323, 324

325
327

328

334
335
336
337
337

CONTENTS

Indian Troops 1938-45
Table 102. Admissions .
Table 103. Deaths
Table 104. Invaliding

Table 105. Admissions, Deaths and ‘Invalids 1925-45

Officers, British and Indian Armies

Table 106. Admissions, Deaths and Invalids 1925-45
Other Ranks, British and Indian

Table 107. Admissions, Deaths and Invalids 1925-45
British and Indian Armies

Table 108. Admissions 1915-18, 1940-45 .

Other Ranks, British and Indian
Table 109. Deaths 1939-45
Table 110. Invalidings 1939-45
Table 111. Venereal Diseases 1938-45
British Other Ranks
Table 112. Effects of Heat 1936-45.
Other Ranks, British and Indian
Table 113. Effects of Heat 1936-45
Table 114. Malaria 1938-45
British and Indian Armies
Table 115. Dysentery and Diarrhoea 1939-45

Table 116. Women’s Services—Admissions 1939-45 .
Table 117. Women’s Services—Deaths 1939-45 .

Table 118. Women’s Services—Invalids 1939-45 .

Table 119. Women’s Services—Average Constantly Sick 1939-45 348

CHAP. IX. SOUTH-EAST ASIA COMMAND .
(1) INDO-BURMA FRONT

Admissions
Tables 120-123. British Troops 1942-45 .
Tables 124-128. Indian Troops 1942-45 .
Table 129. West African Troops 1944-45
Table 130. East African Troops 1944-45 .
Tables 131-132. All Troops 1942-45

Deaths

Table 133. All Troops 1942-45 ‘4
Tables 134-135. Medical Ethnography 1942-45

95

338
339
339
340

+ 340
341
341

342
343
343

344

345
346

347
348
348
348

349
352

384-387
388-392
393

- 394
395-397

- 398
399-400

96 CASUALTIES AND MEDICAL STATISTIUs

(2) CEYLON. 6 . : : . 400
Admissions
Tables 136-138. British Troops 1942-45 . 4 : + 420-422
Tables 139-143. Indian Troops 1942-45 . , F + 423-427
Table 144. East African Troops 1944-45 : : é - 428
Tables 145-147. Ceylonese Troops 1943-45 : + 429-431
Tables 148-149. All Troops 1942-45 : , : + 432-434
Deaths
Table 150. All Troops 1942-45 , : & - 435
Tables 151-153. Medical Ethnography 1942-45 . 3 + 435-437

CHAP. X. DISCHARGES FROM THE ARMY ON MEDICAL GROUNDS 438

Tables 154-158. Males 1943-45. . 4 ‘ - 448-451
Tables 159-161. A.T.S. 1943-45. - i. hs i - 452-453

Note: In some of the tables, the total of the detail does not agree with
that shown. This is due to rates being calculated to the nearest decimal
point. The differences are small.

ABBREVIATIONS, TERMS, ETC. USED IN THIS VOLUME

A.D.M.S,
AF.

B.E.F.
B.N.A. and C.M.F.

GH.Q.
Hallux V. etc.

LA.
LA.T.
I.D.K.

I.M.LN.S.
1.0.R.
Malaria, B.T.
Malaria, M.T.
Malaria, Q.
M.E.F.
M.MLR.

Morbidity
N.A.
N.Cs.(E.)

N.E.A,
NV.

Assistant Director of Medical Services

Army Form

Auxiliary Territorial Service

British Army

British Expeditionary Force

British North African and Central Mediter-
ranean Force

British Other Rank

Deputy Director of Medical Services

Director of Medical Services

Enemy Action (Applied herein to Injuries)

Equivalent Annual Rate. An annual rate calcu-
lated from quarterly rates or from less than
twelve months of the year.

East African Other Rank

Emergency Medical Services

Ear, Nose and Throat

General Headquarters

Includes Hallux Valgus, Varus, Flexus and
Rigidus

Indian Army

Inflammation of the Areolar Tissue

Internal Derangement of the knee.
Includes: Internal Derangement of the knee
and other joints. Subluxation of the intra-
articular cartilage. Rupture of the intra-
articular cartilage. Ruptured crucial ligament
of the knee, and loose body.

Indian Military Nursing Service

Indian Other Rank

Malaria—Benign Tertian

Malaria—Malignant Tertian

Malaria,—Quartan

Middle East Force

Mean Monthly Rate. A rate adjusted to corres-
pond with that for a month of fixed length
30°5 days, almost one-twelfth of a calendar
year.

Sickness from disease as opposed to injury.

Not applicable

Non Combatants (enrolled). Menials employed
in the Indian Army and formerly known as
Followers.

Non-Enemy Action. Applied herein to Injuries

Non-Venereal

97

98 CASUALTIES AND MEDICAL STATISTICS

P.U.O.
Q.A.I.M.N.S.

S.E.A.C.
V.A.D.
V.C.O.

V.D.
W.A.C(L.)
W.AOR,

North West Europe

Not yet diagnosed

Officer in charge of Second Echelon

Other Rank

Persia and Iraq Command

Pyrexia of Unknown Origin

Queen Alexandra’s Imperial Military Nursing
Service

South East Asia Command

Voluntary Aid Detachment

Viceroy’s Commissioned Officer.
Roughly analogous to a Warrant Officer in
the British Army.

Venereal Disease

Women’s Auxiliary Corps (India)

West African Other Ranks

INTRODUCTION

Health statistics of the civilian population as a whole are limited to the
diagnoses of deaths and certain notifiable infectious diseases. This is
primarily due to the fact that no machinery has as yet been devised for
the collection of the relevant statistical raw material. In the army, how-
ever, medical statistics are limited only by the efficiency of the admini-
strative machine in ensuring that medical documents are correctly
completed and sent to their destination promptly and safely.

For the following reasons, the Army can offer far more avenues for
fruitful medical statistical research than does the civilian population:

(a) Every medical unit which treats a soldier completes a standard
form which is available for statistical purposes. (Statistics in
respect of those treated in civil hospitals have hitherto been
virtually unobtainable for the whole civilian population due in
great part to their basic material being so diverse in character
and content that collection, collation, interpretation and publica-
tion were not possible.)

(b) Soldiers are admitted to military medical units for minor diseases
which, in a civilian population, would be treated at home.

The work of the Army Medical Services is at the same time more
limited and more specialised, being restricted with regard to age,
physique and, to a certain degree, sex. It is more extensively concerned
with those tropical and sub-tropical diseases which are encountered so
seldom, if at all, by doctors in civil life.

For convenience, the functions of Army Medical Statistics may be
grouped under three heads:

(a) Current Administration, e.g. incidence of disease; bedstate in-
formation, allocation of hospital accommodation; the assessment
of non-effectiveness of personnel on medical grounds.

(b) Long term planning, e.g. determination of major sources of medical
wastage among different types of personnel in different countries;
the relation of age and sex to wastage, special risks associated
with different trades, arms of service, and ethnic groups.

(c) Research, e.g. the assessment of the efficacy of therapeutic
measures; research in aetiology and epidemiology of diseases.

Before the reorganisation of the Army medical statistical machinery

in 1943, its activities were confined almost exclusively to current ad-
ministration. Compared with the major developments which were then
instituted, the evolution of these statistics was slow. The Army was a

99

100 CASUALTIES AND MEDICAL STATISTICS

pioneer in this field and it will not be uninteresting to trace its
development.

Two early works which deserve attention are Sir John Pringle’s On
the Diseases of the Army, published in 1752, which drew attention to
the connexion between dirt and disease, and Munro’s Account of the
Diseases which were most frequent in British Military Hospitals in Germany
from 1761 to 1763, published in 1764. It was through the initiative of
Munro that admission and discharge books were introduced into Army
hospitals.

Some years later, Alexander Tulloch became interested in Army
mortality in connexion with the problem of Army pensions. He extended
his interests and, in collaboration with Thomas Balfour, published a
series of reports dealing with the health of troops serving in different
countries. These published reports were among the earliest British vital
statistics; they were certainly the earliest among the Armed Forces. The
Navy followed the Army’s lead, as did, in due course, the American,
French, Italian and Prussian forces.

The public clamour over the conditions in Army hospitals in the
Crimea led to the establishment of an investigating committee, among
the members of which were Sidney Herbert and Alexander Tulloch.
Their conclusions, which were published in 1861 as the Report of the
Committee cn the preparaticn of Aimy Medical Statistics and on the duties
to be performed by the Statistical Branch of the Army Medical Department
outlined the statistical policy to be followed. The first Annual Report on
the Health of the Army for that year was produced. Such reports have
been published for each succeeding year, except during the First World
War and during the years 1938 to 1945.

Although the reforms introduced were a considerable achievement,
the Army medical statistical machine was not devised to cope with the
conditions which arose early in the Second World War. Many scrious
problems obtruded themselves and it is of interest to investigate the
difficulties of the organisation, examine the methods by which they
were overcome and trace the development of the system throughout the
war.

Before the outbreak of war, the very few soldiers who were admitted
to civilian hospitals were transferred to military hospitals as soon as
circumstances permitted. With the creation of the Emergency Medical
Services, civilian hospitals, from late in 1939, played an increasingly
greater part in the medical care of Service men and women, until a high
proportion of military patients in the United Kingdom were in civil
hospitals.

At the outset, these hospitals were entirely outside the control of the
army medical authorities. They were thus not obliged to comply with
the army methods of medical documentation and system of returns and

THE ARMY MEDICAL SERVICES 101

it became necessary to obtain information regarding admissions, dis-
charges and transfers of military patients. This was done by means of
E.M.S. Form 105 (Form 404 in Scotland), an administrative form com-
pleted by E.M.S. hospitals. Except for a diagnosis, the forms contained
no medical data. As they were rendered for discharges as well as admis-
sions, and as regimental particulars were often incorrect, the task of
collating the many thousands of forms received was formidable. The
information from this source was entirely unsuitable and insufficient
from a medical point of view.

In addition to the receipt of these forms, Medical Record Cards
({A.F. I.1220) were submitted for all Army patients in military hospitals
at home and abroad. These cards were initiated when a patient was
received as a direct admission or transferred to a military hospital and
sent to the War Office when discharged or transferred. There would thus
be in existence more than one card for a patient transferred from the
military hospital which originally admitted him. The cards contained,
in addition to regimental particulars, medical case notes.

The sorting of the Army and E.M.S. forms provided another problem.
Manual sorting, hitherto employed and suitable for small numbers, was
hopelessly inadequate for the greatly increased numbers arriving daily
at the War Office. The introduction of the Hollerith punched card
system, with the formulation of the necessary codes to cover all the
items of administrative and medical interest, assisted in some measure
the task of sorting and collating information. Because the forms did not
always represent complete hospital cases, all methods of collation which
were tried failed to produce satisfactory results.

It was clear that adequate medical statistics could not be obtained
unless E.M.S. hospitals were persuaded to adopt the army method of
documentation for their military patients and unless arrangements
could be made for one set of Medical Record Cards for one patient to
be submitted on final discharge from hospital irrespective of the number
of transfers between hospitals. In so far as military hospitals were con-
cerned, the latter was purely a medical administrative problem and
easily resolved. Negotiations with the E.M.S. authorities for their
hospitals to adopt military documentation for military patients were
successful, arrangements being made for the new system to commence in
September 1942.

From then, it became possible to produce more reliable statistics, but
due to a variety of reasons, a deficiency of Hollerith cards existed, vis
4 vis patients admitted to hospitals. Among these may be instanced,

(a) Losses in transit from overseas of A.Fs. I.1220, due to enemy
action.

(b) The highly mobile conditions of warfare.

102 CASUALTIES AND MEDICAL STATISTICS

(c) Failure through enemy action or other causes to send record
cards to the War Office.

(d) The lack of experience, from an administrative point of view, of
many medical officers and their omission to initiate the cards.

(e) The impossibility, at least initially, of complete and effective
control over the administration of military patients in civil
hospitals.

There was also the possibility of a slight leakage in the War Office.

A further difficulty arose in that labour problems caused a serious
backlog in coding of documents and the punching of Hollerith cards.
From September 1944, and throughout the remainder of the war,
coding was restricted, in the case of the United Kingdom to ten per
cent. of cases, and for other major commands twenty or fifty per cent.

Because of these deficiencies and restrictions, in the following chapters
where statistics emanating from the punched card system are used,
some assessment is made of the deficiency involved.

The above refers to personal medical records, complete statistics
from which cannot be prepared until patients have been discharged
from hospital, in some cases many months after admission. To provide
a rapid flow of medical statistics regarding the incidence of disease,
deaths, and bedstates, military hospitals before the war were required
to submit, monthly, a return (A.F. A31) giving, inter alia, the numbers
admitted, by disease, deaths, etc. This return, at least in the United
Kingdom, was cancelled early in the war in an over-enthusiastic attempt
to save paper work. No adequate substitutes were introduced until after
the war, although many returns were initiated, modified and subsequent-
ly cancelled.

In some commands overseas, where A.F. A31, or modified versions
thereof, obtained before the war, notably in India and Egypt, the form
continued to be used and was the basic medical statistical return through-
out the war. Indeed, it was adapted for use in a new command, South-
East Asia, on the Indo-Burma Front and in Ceylon. In other overseas
commands, e.g. North Africa and Central Mediterranean Force and
North-West Europe, medical statistical returns were of local pattern
and bore little or no resemblance to A.F. A31 either in format or content.
The difficulties in checking and consolidating forms of such differing
patterns were many and it does not seem unreasonable to suggest that
the same form of medical statistics could have been used throughout
the world wherever British soldiers were stationed. This practice
obtains to-day. One disadvantage of the lack of a standard return is
illustrated in the following pages where the make-up of tabulations
presented for the Middle East (based on A.F. A31) differs from those
for South-East Asia Command (modified A.F. A31) and again fromthose

THE ARMY MEDICAL SERVICES 103

for the North Africa and Central Mediterranean Force (based on local
returns).

Basic military medical statistics required from hospitals and other
medical units fall into four main categories:

(a) Bedstate information (not available for inclusion in this volume).

(b) Admissions (but not transfers) by diagnoses.

(c) Deaths, by causes.

(d) (in overseas commands only) Transfers to the United Kingdom
on medical grounds, by diagnoses.

Returns from Commands and Forces lacked much of this information.
Those from one force contained numbers (without diagnoses) recom-
mended for transfer to the United Kingdom on medical grounds and
however valuable the information was at force headquarters its useful-
ness at the War Office was questionable. Statistics now received in the
War Office contain all the above information on forms standard in all
Commands.

Statistics relating to discharges from the Army on medical grounds
presented little difficulty in their collection. All such discharges took
place in the United Kingdom following military medical boards. They
were carried out by military medical authorities either at military or
E.M.S. hospitals, the latter under the administration of Military Regis-
trars. In 1942 a special report (A.F. B3978) was introduced to record
information regarding each discharge. This form was completed by the
presidents of medical boards and sent to the War Office. It formed the
basic data for the punched card index of medical discharges. This index
was the only exception to the restriction on coding, and from its incep-
tion there was a full coding of the reports until the end of the war, and
subsequently.

The Director-General, Army Medical Services, in 1943, called for
a special report on the existing statistical machine and for the purpose
the services of Professor Lancelot Hogben, F.R.S., was placed at the
disposal of the War Office by the University of Birmingham. Consequent
upon the report submitted, the statistical branch was merged into the
Directorate of Biological Research (later renamed the Directorate of
Medical (Statistical) Research) with Brigadier F, A. E. Crew, F.R.S., as
Director and Professor Hogben as Deputy Director. The directorate
was given wider terms of reference with a greatly increased technical
staff. It was then increasingly possible to deal with statistical matters
other than current medical administration and a programme of research
was initiated. Results of these activities in the extended field were
published in monthly Bulletins of Army Health Statistics inaugurated
in January 1945. Included therein were also statistics relating to current

104 CASUALTIES AND MEDICAL STATISTICS

administration. The main papers in these Bulletins were later incorpo-
rated in the Statistical Report on the Health of the Army, 1943-45,
published by H.M.S.O. in 1948.

As previously noted, annual reports on the Health of the Army were
not published during the war years. The 1943-45 Report did not
bridge the gap from a statistical point of view in that it covered only
three years and was not a comprehensive work with a detailed morbidity
survey covering, at least, all the large commands. For the same reason
it could not be accepted, important as it was, as the Army contribution
to the statistical volume in the Official Medical History of the War
series.

The present contribution includes as much material as possible that
was not published in the 1943-45 Report. In compiling morbidity
statistics, it was the intention to use, whenever the basic data so lent
itself, the conventional yardstick of medical statistics, the rate for 1,000
of the population at risk (the Report dealt mainly with relative rates).
This was found possible for all Commands dealt with herein, except for
West Africa. Here, the basic materials were the Annual Hygiene Reports
which contained no crude figures for admissions to hospitals, etc., but
only relative rates. In passing, it may be mentioned that only in the
chapter relating to West Africa are there some tables identical with
those in the 1943-45 Report. This is due to the somewhat limited
annual reports for that Command being used as basic data for both
purposes.

Because of the limitations inherent in the medical index of punched
cards at the War Office, it was felt that, wherever possible, reliance
should be placed upon returns and reports and only where no adequate
or reliable statistics could be obtained from these sources should calcu-
lations based on Hollerith tabulations be used. Sufficient data was found
to provide material for the chapters relating to the Middle East Force,
North Africa and Central Mediterranean Force, East and West Africa
Commands, India, the Indo-Burma Front and Ceylon. The search for
records relating to other spheres of activities proved disappointing and
a combination of Hollerith tabulations and other data is used for chapters
relating to the B.E.F. France and North-West Europe. Only for the
United Kingdom and the chapter relating to discharges from the Army
on medical grounds are statistics based on Hollerith tabulations. It was
disappointing, too, that no reliable, accurate, and complete statistical
data existed for such campaigns as Greece and Crete (1941), Greece
(1944), Norway, Arakan, etc. Statistics in respect of these were merged
into those of the Force or Command which supplied the forces operating
there.*

* Some statistical data for these campaigns may be found in the Army Medical
Services, Campaigns volumes in this series.

THE ARMY MEDICAL SERVICES 105

The geographical disposition of the Army and the channels of com-
munication, suggest that the logical manner of treatment of Army
Medical Statistics would be on similar lines. This has been followed in
the present volume. In dealing with the Middle East Force, it was found
to be possible to divide the statistics into smaller geographical (command)
groups. Further, in some commands, where Colonial and Dominion
troops were serving with British, it has been possible to discuss the
special medical risks which attach to each different ethnic group.

It may not be out of place to mention here some of the outstanding
features recorded in the following pages. In so far as admissions for
diseases are concerned, the highest recorded rate among British Troops
occurred in 1943 on the Indo-Burma Front when the exceptionally high
figure of 1,746 per 1,000 other ranks was registered. In the following
year the rate fell to 1,334 and, in 1945, to 780, less than half the peak
rate. Admissions for disease in Ceylon also registered a high rate, that of
1,094 per 1,000 in 1942, but by 1945 it had fallen to just over one-half at
584. Perhaps the healthiest of the larger overseas commands was the
Middle East where the rate of admission for disease ranged from a peak
of 677 in 1941 to 380 per 1,000 in 1945.

The remarkable decline in admissions on the Indo-Burma Front and
in Ceylon were mainly due to the dramatic reduction in the incidence of
malaria, which was not confined to these two Commands. Admission
fates per 1,000 strength for malaria among British Troops were as
follows:

1942-1943 19441945

Indo-Burma Front . . - 335 628 406 128
Ceylon . 7 d 7 . 278 254 82 36
India. 7 : . 164 198 248 131
North Africa and Central

Mediterranean. 2 4S _ 76 19
Middle East . : : > ag 24 42 22

On the Indo-Burma Front, the peak rate of 628 per 1,000 in 1943 was
reduced by four-fifths in two years. In Ceylon the peak figure of 278 in
1942 was reduced to approximately one-eighth by 1945. The decline in
India in 1945 was nearly fifty per cent. of the rate obtaining in the
previous year. A record low rate of 34 per 1,000 was reached in 1946
which compares very favourably with the pre-war figure of 50 per 1,000
in 1938. The figures from the Middle East and Central Mediterranean
also show reductions in 1945, the former by one-half and the latter by
three-quarters of the peak rates, both of which occurred in 1944. These
striking results are not only a tribute to medical science but also to the
Army Medical Services through anti-malaria training and discipline

10 CASUALTIES AND MEDICAL STATISTICS

among all ranks, the suppressive treatment enforced and to the work of
Anti-Malaria Units of which one hundred and fifteen were operating
in India, Burma and Ceylon when the war ended.

Another factor in the decline of admissions on the Indo-Burma Front
was the reduction in the number of dysentery cases by fifty per cent. in
two years. The peak rate of 132 per 1,000 was followed by 97 in 1944
and 65 in 1945. A reduction in admissions for dysentery also occurred
in the Central Mediterranean where a rate of 4 in 1945 was preceded
by 12 per 1,000. In the other tropical and sub-tropical commands no
reduction was witnessed.

In all major commands except one, the incidence of admissions for
mental diseases increased annually with the peak rate in 1945. The
exception was in the Middle East where yearly declines followed the
peak rate in 1942. Rates per 1,000 were as follows:

1940 1942 1945
Indo-Burma Front. _- 3 23
India . 5 - ih 3 5 3
Ceylon . : 3 = 5 10
Middle East . F 5 6 20 5
United Kingdom . . 4 7 8

The reasons for these increases were probably the cumulative effect
of the stress and strain of war coupled with more accurate diagnoses
following the increase in the number of psychiatrists available.

In Chapter XI is discussed the recovery rate of those other ranks
wounded in North-West Europe from the landings in Normandy to the
cessation of fighting. It is noted there that deaths from wounds was
seven per cent., so that the chances of survival after being wounded
were ninety-three per cent. Invalidings from the Army of these soldiers
accounted for fourteen per cent., so that from the Army point of view
of wastage, the recovery rate was seventy-nine per cent. Many of those
wounded were, however, fit for some degree of civil employment and
if a disability of forty per cent. or less is taken as the criterion for a
reasonably wide range of employment, one third of the injured made
a good recovery. Thus, with deaths from wounds at seven per cent. and
invalids fit for no employment or in a restricted capacity at nine per
cent., the recovery rate was eighty four per cent.

The first chapter deals with diseases and injuries of British troops in
the United Kingdom. This is followed by one relating to the British
Expeditionary Force to France in 1939 and those to other commands
and forces overseas according to their proximity to England. Finally, a
chapter on discharges from the Army on medical grounds is presented.
Due to the non-availability of data, it is not possible to include an
account of the morbidity of the entire British Army for the war years.

CHAPTER I

THE UNITED KINGDOM

HE STATISTICS which follow emanate from tabulations produced

by the Hollerith Section of the War Office. In spite of the known

limitations of these tabulations, this course was inevitable, and

was entirely due to there being no other sources from which the informa-

tion could be obtained. Up to 1940, statistical data regarding admissions

to and deaths in hospital, etc., were received in the War Office monthly.

In 1940 these returns were cancelled and no satisfactory substitute was
provided.

From the outbreak of war, Service patients were admitted to hospitals
under the aegis of the Emergency Medical Services as well as to Service
hospitals. No returns or Hospital Record Cards (A.F.I.1220) in respect
of Army patients were received from E.M.S. Hospitals until 1942, when
such hospitals were persuaded to compile A.Fs. I.1220 for these patients.
As these cards are the basic data from which information is transferred
to Hollerith punched cards, it follows that the Hollerith tabulations for
1940 to 1942 contain data relating only to:

(a) those admitted to Military Hospitals and

(b) those transferred from other types of hospitals in the United

Kingdon, including those of the E.M.S.
They do not include patients treated exclusively in E.M.S. Hospitals.*
The tabulations for the years 1943 to 1945 include all known Army
patients admitted to all types of hospitals in the United Kingdom.

The number of Army patients admitted to E.M.S. Hospitals in 1943
and 1944 are known and the following analysis shows these admissions
as a percentage of those recorded on Hollerith cards.

Class of Troops | 1943 1944

Males ‘ ‘ 57 55

Females. : 68 66
All . ‘ 58 57

The tabulations relating to admissions to hospitals do not include
any patients transferred from hospitals outside the United Kingdom.
Such casualties are rightly included in the statistics of the overseas
command in which they originated. On the other hand, any such patients

* See Emergency Medical Services, Part I. Service Patients, pp. 647 et seq.
107

108 CASUALTIES AND MEDICAL STATISTICS

transferred who subsequently died while still serving are included in the
mortality tabulations in this section.

Initially, a Hollerith card was punched for all A.Fs. I.1220 received
in the War Office. As from September 1, 1944, however, in an effort to
conserve labour and supplies, it was decided to code and punch only
ten per cent. of these forms. Furthermore, the amount of information to
be transferred to the Hollerith cards was restricted to ten items, instead
of the twenty-one previously coded.

The decision to restrict the punching of cards to a ten per cent.
sample was implemented by selecting A.Fs. I.1220 of those patients, the
Army or personal number of whom ended with the digit 5.

Among the information not now coded under the new procedure was
‘Result on Discharge’. This stated whether the patient was returned to
his unit, died, or was discharged from the Army as an invalid. Consequent
upon this, it is not possible to present annual mortality rates after 1943.

As there are no data in existence to act as controls, it cannot be
ascertained what discrepancy exists, if any, in the numberof A.Fs. I.1220
received, and that appearing in the Hollerith tabulations, neither is it
possible to proffer any estimate, within reasonable limits. For what it is
worth, however, it has been calculated that the deficiency in Hollerith
cards vis d vis A.Fs. I.1220 relating to patients admitted to hospitals in
North-West Europe, was in the region of twenty per cent. (see ‘North-
West Europe’, Chapter III). It is known that the number of admissions
during 1946 in the United Kingdom listed in the Hollerith tabulations
was less than that enumerated in returns from hospitals by approximately
thirty per cent. of the total recorded in the tabulations.

In calculating annual rates, annual strengths obtained from the mean
of average quarterly strengths were used. These annual strengths
fluctuated somewhat, being highest in 1941 and 1942 and lowest in 1945.
If the 1940 strength is taken as 100, variations are as below:

Variations in Strength of British Troops in the United Kingdom

Male Female
Year Officers Other Ranks All Ranks All Ranks
19490 100 100 100 100
1941 157 137 138 173
1942 163 134 136 447
1943 147 118 119 652
1944 135 101 102 655
1945 99 79 80 537

Tosummarise, Hollerith tabulations for admissions to, and deaths in,
hospitals in the United Kingdom suffer from the following defects,
which apply to members of both the male and female Services:

THE ARMY MEDICAL SERVICES 109

(a) Admissions to, and deaths in, E.M.S. Hospitals from the outbreak
of war to some time in 1942 are not included.

(5) An unknown number of transfers from E.M.S. to Military
Hospitals from January 1940 to August 1942 and included in the
Hollerith tabulations tends to reduce the overall discrepancy.

(c) From September 1944, only ten per cent. of admissions were
coded.

(d) There is a strong possibility that the Hollerith tabulations are
deficient by at least twenty per cent.

(e) Deaths were not coded from September 1944.

(f) There may be a small deficiency in Hollerith cards, vis a4 vis
A.Fs. 1.1220 received in the War Office.

Any discussion on the statistics which follow must necessarily be limited
by these factors.

Tabulations, separately for the male and female Services, are presented
in respect of:

(a) Rates of admissions to hospitals per 1,000 strength annually, 1940

to 1945, by causes.

(b) Relative rates of admissions annually, by causes.

(c) Comparative rates of admissions annually, by causes.

(d) Breakdown of admissions to hospitals for injuries.

(e) Average rates of admissions to hospitals, by causes, for the six
years 1940 to 1945.

(f) Relative Mortality Rates, annually, 1940-43.

In the tabulations relating to comparative rates of admissions, 1943
has been taken as the base year, because this year was the first full year
in which admissions to all types of hospitals are known.

It is emphasised that the statistics in this chapter deal with admissions
to and deaths in hospitals only. Admissions to other medical units,
except where they result in transfers to hospitals are not included.
Care should therefore be exercised in comparing rates herein with those
in post-war annual reports which sometimes include in their totals
admissions to all medical units.

Advantage is being taken of including herein a tabulation of admissions
to hospitals in 1939, hitherto unpublished.

BRITISH MALE TROOPS

Rates of admission to hospitals in the United Kingdom of British
Army males, based on Hollerith tabulations, are presented in Tables 1
to 6. Table 2 records rates per 1,000 strength, Table 3 cites relative rates

110 CASUALTIES AND MEDICAL STATISTICS

and Table 4 compares admissions in 1943 with those of the other years
under review. Table 4 records the average rates of admission for the six
years, while Tables 5 and 6 present a breakdown of admissions through
injury. Mortality rates for the years 1940 to 1945 are exhibited in Tables
7 and 8. Admission rates for 1939 are included as Table 16.

Because of the limitations mentioned in the preamble to this chapter,
it is not considered advisable to use the rates cited as morbidity rates
without adjustment. For this purpose, and as a rough guide, it is
suggested that the following correction factors will neutralise the
deficiencies to a great extent.

1940 and 1941—between 2:0 and 2-5
1942 —between 1°5 and 2-0
1943 to 1945 —1°3

Exceptions to this are the rates for Mental and Venereal Diseases.
Patients suffering from these diseases passed through military hospitals
during the course of their treatment and are thus recorded in the
tabulations. Because of this the correction factor of 1-3 should be applied
to these disease rates in all years.

Admissions for diseases only ranged from 103 per 1,000 in 1941 to
153 in 1945, while those for injuries varied from 5 in 1940 to 19 in 1943.
Admissions on account of injuries comprised from five to eleven per
cent. of the total.

Relevant rates, to the nearest whole number, were as follows:

United Kingdom, 1940-45
Rates of Admissions to Hospitals, British Troops, Male
Source: Hollerith Tabulations

Rates per 1,000 Strength Relative Rates Comparative Rates

Year | Disease} Injury | Totals | Disease| Injury | Totals | Disease| Injury | Totals

1940 | 105 5 110 95 5 100 72 29 67
1941 103 6 109 94 6 100 vhs 34 66
1942 137 16 152 go 10 100 94 83 93
1943 146 19 164 89 1 100 100 100 100
1944 129 16 144 89 Ir 100 88 83 88
1945 153 18 170 go 10 100 105 94 104

The highest recorded annual rate was in 1945 at 170 per 1,000. In the
same year was registered the highest rate of admissions for diseases only,
153 per 1,000, while the peak of admissions on account of injuries
occurred in 1943 at 19 per 1,000. Injuries were responsible for five and
six per cent. of admissions in 1940 and 1941 and ten and eleven per cent.
for the remainder of the years. Over the period there was recorded an
average rate of 129 for disease and 13 for injury, a total of 142 per 1,000.

THE ARMY MEDICAL SERVICES It

Applying the correction factors noted above, adjusted admission rates
per 1,000 strengths would be in the region of

1940—between 220 and 275
1941—between 220 and 275
1942—between 230 and 305
1943—213
1944—187
1945—221

DISEASES OF THE DIGESTIVE SYSTEM

Of individual diseases and disease groups, Diseases of the Digestive
System were responsible for the highest rates of admissions, being fifty
per cent. more than those for Diseases of the Skin, which followed in
order of numerical importance. Recorded rates ranged from 14 per 1,000
in 1940 and 1941 to 23 in 1945. Expressed as a percentage of admissions
for disease, these rates represent 13 in 1940, and 15 per cent. in 1943 and
1945. The average rate of admission over the six years was 19 per 1,000.
An analysis of admissions for this group of diseases follows on page 112.

Numerically, HERNIAS were the most important contributory cause of
admissions in this group of diseases. Rates varied from 3 per 1,000 in
1940 to 7 in 1945. The 1943 rate of 5-8 fell to 4-4 in the following year
but increased to 6-9 in 1945. Expressed as percentages of the total of
the group, the 1940 and 1944 admissions represent twenty-four, the 1941
and 1943 admissions twenty-six, those for 1942 twenty-seven, while
admissions in 1945 were some thirty per cent. The average rate over the
six years at just under 5 per 1,000 was slightly in excess of one quarter
the total of the group. Admissions in 1944 were three quarters of and,
in 1945, one-fifth more than the rates for 1943.

Next in order of numerical importance were admissions in respect of
DYSPEPSIA and GASTRITIS. Rates which varied slightly throughout the six
years, increased from 2-8 in 1940 to 3-8 in 1942 then declined each year
toa final 2-7 per 1,000 in 1945. The relative rates are interesting in that
they exhibit a decline each year from twenty one per cent. in 1941 to
eleven in 1945. Admission rates for 1944 and 1945 were slightly less than
three-quarters that for 1943.

Admissions for APPENDICITIS were, on the average, one half those for
HERNIAS. Apart from slight declines in 1941 and 1944, rates increased
annually from 1-8 in 1940 to 3°7 in 1945. The rate in 1943 was a little
under 1 per 1,000 less than that in 1945. Admissions over the period
were some thirteen per cent. of the group total. In 1944 the relative rate
increased by one per cent. to fourteen and this was followed by sixteen

112 CASUALTIES AND MEDICAL STATISTICS

United Kingdom, 1940-45

Admissions to Hospitals for Diseases of the Digestive System. British Troops, Male
Annual Rates per 1,000 Strength with Relative and Comparative Rates

Source: Hollerith Tabulations

1. Annual Rates per1,o00 Strength} 1940 1941 1942 1943 1944 1945 | Averages
Gastric Ulcers . ? 0°44 0°30 0-22 0°31 0°27 0°35 0-32
Duodenal Ulcers. % 1°44 12: 1:07 2°43 1'4r 1°70 1°38
Peptic Ulcers, Unspecified 0°40 or oO o o-10 0-20 o'17
Perforation of Ulcers Fe 0°07 our ovr Or17 O-17 0-25 os
Dyspepsia and Gastritis . . | 2°80 2°87 37 3°69 2:67 2°67 3°
yt is : : + | 3:27 3°61 5°61 5°82 4°40 6:93 4:95
1°80 1°58 2°66 2°77 2°55 a 2°50
0°88 118 2°26 2°39 1°89 2-13 1°79
Other Causes 2°66 2°85 5°31 5°30 4°78 5°87 44
Totals e “ ¥ . | 13°76 13°91 ar-18 21°96 18-21 23°46 18°75
Percentages of total admissions
for diseases : : A 13 4 1s 1s 14 1s 1s
2. Relative Rates
Gastric Ulcers F : * 3 2 I I I 1 2
Duodenal Ulcers... . eg 9 5 7 8 7 7
Peptic Ulcers, Unspecified 3 1 0-4 o-4 1 H H
Perforation of Ulcers. 1 ' 9-5 1 1 1 t
ia and Gastritis : 20 21 18 17 15 ir 16
x $ é 24 26 az 26 24 go 26
4 coy 13 13 14 16 13
8 mW ur 10 9 10
19 21 25 24 26 24 24
100 100 100 100 100 100 100
3- Comparative Rates(1943 = 100)
Gastric Ulcers . .
Duodenal Ulcers: ;
Peptic Ulcers, Unspecified
Perforation of Uleers
Dyspepsia and Gastritis .
Hernia . . . .
Appendicitis |
laemorrhoids
Other Causes
Totals

per cent. In contrast to this the comparative rate in 1944 fell from 100 to
g2 and increased to 132 in 1945.

Rates of admissions on account of HAEMORRHOIDS increased from an
initial low figure of just under 1 per 1,000 to 2-4 in 1943, declined to
1°9 in 1944 and finally registered 2-1 per 1,000 in 1945. The average
rate of 1-8 was ten per cent. of the group total. The admission rate in
1944 was slightly over three-quarters that in the previous year and the
rate in 1945 was also lower, by approximately one-tenth.

Of admissions for Ulcers, those for DUODENAL ULCERS were the more
numerous, being twice the total of the remainder. Admissions declined
from 1-4 in 1940 to 1-1 in 1942, then increased to 1°7 in 1945. They
contributed, on the average, some seven per cent. of the total admissions

THE ARMY MEDICAL SERVICES 113

of the group. A similar trend in admissions was exhibited by both
GASTRIC and UNSPECIFIED PEPTIC ULCERS in that a decline from 1940 to
the mid-years of the period was followed by annual increases. The
average rate of admissions for Gastric Ulcers was 0-3 per 1,000, while
that for unspecified Peptic Ulcers was 0-2. Admissions for PERFORATED
ULCERS increased steadily from 0-07 in 1940 to 0:25 in 1945 with an
average rate of 0-17 per 1,000 which represented one per cent. of the
group total.

DISEASES OF THE SKIN

Following diseases of the Digestive System in order of numerical
importance came Diseases of the Skin, admission rates for which
increased from 8 per 1,000 in 1940 to 16 in 1943, then fell to 14 in 1945.
These admissions, which averaged approximately ten per cent. of all
admissions for diseases are analysed in the tables on page 114.

One quarter of admissions of this group were attributable to IMPETIGO,
rates for which increased from 2-5 per 1,000 in 1940 to a peak of 4:5 in
1942. Thereafter admissions declined from 4-2 in 1943 to 2:2 in 1945.
They were approximately one-third of the total for the group in the
first three years, one-quarter in 1943 and one-sixth in 1945. With
admissions for Dermatitis, they accounted for nearly one-half of the
total for the group.

DERMATITIS was responsible for one-fifth of admissions for the group.
Apart from a slight fall in 1944, rates increased steadily over the years
from 1-5 in 1940 to 3-3 in 1943 and 3-7 in 1945, with an average of 2-6
per 1,000. Relative rates ranged between 15 in 1942 and 26 in 1943.
Compared with 1943, admissions were seven per cent. lower in 1944,
but twelve per cent. higher in 1945.

Although admissions for BOILs fluctuated between 0-6 in 1940 to 1°35
in 1943, expressed as a proportion of group admissions, they were stable
at eight per cent. in the first two and nine per cent. each in the following
four years. The rate in 1944 (1°17) was six-sevenths that in 1943 and in
1945 it was slightly less, by two per cent., of 1943 admissions, at 1°32.
The average rate for the six years was I per 1,000.

Diseases of the SsEBACEOUS GLANDS were responsible for seven per cent.
of the group admissions at rates which, commencing at 0-4 reached 1-3
in 1943 before declining to 1-1 in 1945, averaging 0-9 per 1,000 over the
six years. ECZEMA, next in numerical importance, caused an average rate

of 0-8 over the period. Annual rates commenced at 0-5 in 1940 and
increased annually to just over 1 per 1,000 in 1945.

114 CASUALTIES AND MEDICAL STATISTICS

United Kingdom, 1940-45
Admissions to Hospitals for Diseases of the Skin. British Troops, Male
Annual Rates per 1,000 Strength with Relative and Comparative Rates

Source: Hollerith Tabulations

1. Annual Rates pert,ooo Strength} 1940 1941 1942 1943 1944 1945 | Averages
Impetigo 2°s1 g:2r 4°47 4:19 2°91 2°23 3°35
Dermatitis rrf2 | 3:90 | arop | 3:34 | 3:09 | 3:73 2-61
4 0:64 0-79 wen 1-35 117 1°32 1:07
Carbuncles o-2l 0°27 0°60 0°72 0°60 od o"§s
Eczema 0°47 0°56 o'77 100 0°98 Ne o-8r
Warts. 0-14 | 0-29 | 0-45 | 0-6r | 0-57 | 0°69 | 0°46
rrorisel is ras O-31 0°48 0°53 0:33 0°63 sag
0°s3 0°67 Oo o-7r 0-3! o oO
Diseases of the: Be | Ae - .
Sebaceous Glands o-41 0:60 10s 1°29 1°06 113 0°92
Sweat Glands and Ducts 0-0: 0-0: 0-0) on 0°08 on 0°08
Hair and Follicles fe o-2 0-3! o-ak oad 0-42 0-3! 0°40
jails . . . . 0-02 O-or o-or 0-02 o-oz 0°03 0-02
Other Causes 0°73 0°80 123 1-St 1°32 1°59 1°20
Totals 7B 9°82 | 13°60 | 15°88 | 12-97 | 14°16 | 12°37
Percenta, of total admissions
for diseases ~ . . 7 10 9 au 10 9 10
2. Relative Rates
Impetigo 32 33 33 26 22 16 26
Dermatitis 20 a 15 ar a4 26 ar
Boils 8 9 9 9 3 9
Exema a 3 é j i ;
Eczema 7 7
Warts | 2 3 3 4 4 s 4
rors ral ie Pie Me Gc
inea 2
Diseases of the .
Sebaceous Glands 5 6 8 8 8 8 7
Sweat Glands and Ducts 0-4! 0-3) o'4 0:8) 0°6) 1 I
Rae and Follicles 3 4 4 3 3 3 3
jails . o-2 orn orn, or oO” 0-2 on
omer Causes | 9 8 9 10 10 ir 10
Totals 100 100 100 100 100 100 100
3. Comparative Rates(1943 = 100)
Impetigo
Dermatitis
Boils.
Carbuncles .
Eczema
Warts.
Psoriasis
Tinea . .
Diseases of the:

Sebaceous Glands

Sweat Glands and Ducts

Hise and Follicles: .
omer Causes”

Totals

Rates of admission increased over the years for the following:
which increased from with an average of

CARBUNCLES 0°26 to 0-84 0°55
WARTS 0°14 to 0-69 0°46
PSORIASIS 0°25 to 0°63 0°42
Diseases of the

HAIR AND FOLLICLES 0-26 to 0°38 0°40

SWEAT GLANDS AND DUCTS 0°03 too-14 0:08

THE ARMY MEDICAL SERVICES 115

In contrast to these, admissions for TINEA increased from 0-5 to 0-8
in 1942 before declining to 0-4 in 1945, with an average rate of 0-6 per
1,000.

DISEASES OF THE EAR, NOSE AND THROAT

Recorded admissions to hospitals on account of this group of diseases
averaged 12 per 1,000 over the years 1940-45. In two years the average
was exceeded, by 2 and 1 per 1,000 in 1943 and 1945 respectively.
In 1940, 1942 and 1944 annual rates were slightly (from 0-02 to 0-39)
lower than the average, but in 1941 it was 2-5 per 1,000 less. Annual
rates ranged from g to an increase of fifty per cent. at 14. Admissions are
analysed in the tables presented hereunder.

United Kingdom, 1940-45
Admissions to Hospitals for Diseases of the Ear, Nose and Throat.

British Troops, Male
Annual Rates per 1,000 Strength with Relative and Comparative Rates

Source: Hollerith Tabulations

1. Annual Rates pert,ooo Strength| 1940 1941 1942 1943 1944 1945 | Averages
Otitis Media . 0°89 0°86 1°26 1:60 r4r 1°38 1°23
‘Tonsillitis 5°23 4°65 5°99 6-97 5°65 6-42 5°82
Deformities of the Nasal Septum 0°43 0°77 0-82 0°78 o's9 0°93 O72
Laryngitis 0°52 0-28 0°32 0-29 O18 0-29 0°30
Pheryngitis 2°76 104 o'By 0°97 0°53 0°67 reg
Other Causes 74 1-70 2-60 3°36 3°10 3°37 2°65

Totals a % : ~ | nes? 9°30 11°83 13°97 11°46 12°97 11°85
Percentages of total admissions

for diseases. é f 11 9 9 10 9 9 9

2. Relative Rates
Otitis Media. =. 2. | 7-70 | gag | 10-64 | r1-48 | 12-29 10
Tonsillitis 45:19 | 49-99 | 50-63 | 49°88 | 49-31 49
Deformities of the Nasal Seprum 3:72 "33 7:02 5°54 5-19 6
Laryngitis. 4°48 3-01 2:67 2-06 1°53 3
Pharyngitis >] ] | 23-87 | 11-20 | 7-07 | 6:06 | 4-65 10
Other Causes 2 ff | s-0g | 18-23 | 24-97 | 24-08 | 27-03 22

Totals . . . . 100 100 100 100 100 100 100
3. Comparative Rates (1943 = 100)

|

Otitis Media... 2 or 54 79 100 88 86
Tonsillitis 7s 67 86 100 81 92
Deformities of the Nasal Septum 53 99 105 100 76 119
Laryngitis 179 97 110 100 62 69
Pharyngitis it ME 285 107 87 100 ss 69
Other Causes ‘ sie Nis 52 51 77 100 92 100

Totals . . 5 5 83 67 85 100 82 93

Admissions for this group of diseases were, on the average, some nine
per cent. of the total admissions for diseases. TONSILLITIS was responsible
for approximately one half the group total, and admissions on this
account ranged from 5 per 1,000 in 1941 to a peak of 7 in 1943. Rates in
1944 and 1945, at 5-7 and 6-4 respectively, were eighty and ninety per
cent. of those recorded in 1943.

scum

116 CASUALTIES AND MEDICAL STATISTICS

OTITIS MEDIA accounted for admissions at rates varying from 0-9 in
1940 and 1941 to 1-6 in 1943, with an average of 1-2 per 1,000. These
admissions were from eight to twelve per cent. of the total for the group
and in 1944 and 1945, at approximately 1-4, they were somewhat less
than ninety per cent. the rate in 1943.

Admissions for PHARYNGITIS were only slightly less than those for
Otitis Media and one-fifth the rates for Tonsillitis. They were notable
for the comparatively high rate of 2-8 per 1,000 in 1940, over three
times the average for the following five years. In 1941 the rate had fallen
to 1 per 1,000 and by 1945 had declined to 0-7, some seventy per cent.
of that in 1943.

DEFORMITIES of the NASAL SEPTUM caused admissions which increased
from 0-4 per 1,000 in 1940 to 0-g in 1945, with an average of 0-7.
They were some six per cent. of the group total. Admissions for
LARYNGITIS were comparatively high in 1940 at 0-5 per 1,000. They
declined to 0-29 by 1945, the average rate being 0-3 per 1,000.

DISEASES OF THE MUSCULO-SKELETAL SYSTEM

Rates of admission on account of this group of diseases ranged from
slightly under 8 per 1,000 in 1941 to just over 14 in 1943, an increase
of eighty per cent. These rates represented eight and ten per cent. of all
admissions for disease, while the average rate of 11 per 1,000 was between
eight and nine per cent. of such admissions.

A breakdown to component diseases is given below:

Umted Kingdom, 1940-45
Admissions to Hospital for Diseases of the Musculo-Skeletal System
British Troops, Male
Annual Rates per 1,000 Strength uith Relative and Comparative Rates

Source: Hollerith Tabulations

1. Annual Rates ber, 000 Strength!

Diseases of the Jotni 1940 1945 verages
Synovitis . o-91 0°84 1:07 er
Arthritis. 0-30 0-25 0°50 nas
LD.K* 1°32 122 2°47 2°04

. or ° 0-27 0-29

Diseases of the Bone 0-3 ° 0°59 0-42

Diseases of the Sj E 0-09 ° o-31 0°20
iseases of the Muscle 0°03 ° 0°03 0-06

Disteres the Fasciae, Tendons,

Sheath and Biriae:
Bursts . . 0°26 o 0°48 0°44

Diseatet and Deformities'of the| °** | © Sees tee
I ing Te ils 8

ny ‘oensi 0-32 ° 0-3 0°42

I Rested fingers . 0°45 ° 1°38 1°28
Hallux V., etc.t . 0°39 ° 0-38 on

senna ‘oe 0°30 ° 0°08 oie
0°57 ° oO o-

Rheumatic Conditions: 2 “ 2
Non-Articular 2 . 2°13 a 219 2-4
Articular . : . + | e729 0°32 0°67 0-4!
Totals . . : «| 8:09 7°78 s g 11°48 | 11-00

Percent of total admissions

for dis ‘: . E; 8 8 9

THE ARMY MEDICAL SERVICES 117

Admission to Hospital for Diseases of the Musculo-Skeletal System—continued

Diseases of the Joints:
Synovitis . 11-31 10°79; 10-62 10°67 9°82 9°29 10°36
Arthritis. 3:23 | 3:2 3:37 | ger | g-a0 | 4:37 | 3-82
1D.Ke . 36°27 | 38°71 19°14 | 18-67 | 18-23 | arcs 18°55
honey ai . 1°80 7°26 2-21 2°16 1°84 2:38 ae
Diseases of the Bone 4°39 | 4:00 3:59 3°47 2°73 sir 3°82
Diseases of the Spine 1°16 1-60 1°54 ia 1°65 2°70 1°82
Diseases of the Muscle 0°37 0°57 0°84 ° 5S 0°39 0°44 o'ss
Diseases of the Fasciae, Tendons,
ie Tendon ‘Sheath and Bursae. ‘ 3 ‘
jursitis =. 3°25 3's 3°85 4's 4:37 ar 700
Others . . 2°73 gia 3°25 3°73 3°58 4 8 3°55
Diseases end Deformities of the
mos:
I ing Toenails 3:90 | 3:87 | 3:78 | 3:79 | 3:96 | 3:3 3°82
Infected Engers ¥ 5°58 7°49 10°25 14¢Ir 17°08 eae 11°63
Hallux V., etc.t 43: 3°32 1-977 O97 0°70 ovr 1°73
Hammer Toe 3°66 2°62 1-7 118 0°92 o°7r 1°63
: 7:07 3°20 | 7°34 | 4:3) 4 4°29 +09
Rheumatic Conditions:t ° ‘
Non-Artic 26°34 | 25°57 | 22° 21°86 | 22-20 | 19°05 | 22°6
Articular 3°63 | 4:12 | 3:7 4:18 | 4:27 | 5°87 | 4:3!
Totals 100 100 100 100 100 100 100

Rheumatic Conditions: it
Articular

Non-. . : 68 64 100 83 7°
Articular . $ z . 48 53 100 82 112
Totals S 5 s R s7 ss 100 8r 81

D.K. includes: Internal derangement of knee and other joints, Subluxation of intra-articular
Le ture of ieee ene cartilage, pu Yocuor ide of knee, and loose body.

, etc. includes: luxe varus, or
t Rheumatic Conditions excludes Rheumatic Fever.

One-third of the admissions in this group was due to Diseases of the
JOINTS of which INTERNAL DERANGEMENT of the KNEE constituted over
fifty per cent. Admissions for the latter ranged between 1-2 in 1941 and
2-7 in 1943 with an average of 2 per 1,000. They were approximately
nineteen per cent. of the total of the group. syNOvITIS was responsible
for admissions at the average rate of slightly over 1, ARTHRITIS for 0-4
and OTHER DISEASES of the JOINTS for 0-3, per 1,000.

RHEUMATIC CONDITIONS (excluding Rheumatic Fever) caused
admissions at 3 per 1,000, approximately one quarter of the group.
The non-articular type accounted for five times the admissions for the

118 CASUALTIES AND MEDICAL STATISTICS

articular type. The former commenced at 2-1 per 1,000 in 1940 and
increased to 3-1 in 1943 before subsiding to 2-2 in 1945. The latter, on
the other hand, increased steadily from 0-29 to 0-67 over the period.

Admissions due to DISEASES and DEFORMITIES of the LIMBS were slightly
under one quarter of the total admissions of the group. INFECTED FINGERS
caused rates which, commencing at 0-45 in 1940, rose to 2-01 in 1943
and declined to 1-38 in 1945, with an average of 1-28. These represented
nearly twelve per cent. of group admissions. Admissions for INGROWING
TOENAILS experienced a similar trend in rising from 0-32 in 1940 to 0-54
in 1943 and subsiding to 0-38 in 1945. The rates for HALLUX VALGUS et al,
as well as those for HAMMER TOES exhibited a somewhat different
tendency with declining annual rates from 0-39 and 0-30 respectively in
1940 to 0:08 in 1945.

VENEREAL DISEASES

Army personnel contracting Venereal Diseases were normally treated
in Military Hospitals, and only a comparative few were cared for in
E.M.S. Hospitals. Admissions on account of Venereal Disease in 1940
were at the rate of 7 per 1,000, representing some seven per cent. of the
total admissions due to diseases. A rise of 3 per 1,000 in 1941 was
followed by a further rise of 3 in the following year, bringing the rate
to a peak of 14, equivalent to ten per cent. of the total disease rate. In
1943 and 1944 admissions declined to 11 and g per 1,000 respectively,
but in the next year they increased to 13. The average rate of slightly
under 11 represents some eight per cent. of the admissions for all
diseases. Admissions are analysed in the tables on page 119.

As could be expected, admissions for GONORRHOEA were much
more numerous than those for the other classes, being nearly three-
quarters of the total of the group. This being so, the trend of admissions
is that of all Venereal Disease admissions. Rates at 6 in 1940 increased
to 9 in 1941 and 11 in 1942. A decline of 3 per 1,000 occurred in 1943
and this was followed by a similar fall to 5 in 1944 before increasing to
g in 1945. The average rate of admissions was 8 per 1,000. In spite of
the increases in admissions, relative rates decreased from 86 in 1940 to
58 in 1944 with an increase to a final rate of 67 in 1945.

Admissions for sYPHILIS increased annually from o-g in 1940 to
between three and four times at over 3 per 1,000 in 1945 with an average
of 2 per 1,000. Expressed as percentages of all admissions for the group,
they increased from twelve per cent. in 1940 to twenty-eight in 1944 and
were on the average twenty per cent. of all admissions for Venereal
Disease.

The comparatively few admissions due to SOFT CHANCRE recorded
rates of 0-06 in 1941 to 0-02 in 1945 with an average of 0-04 per 1,000.

THE ARMY MEDICAL SERVICES 119

United Kingdom, 1940-45

Admissions to Hospitals for Venereal Diseases
British Troops, Male
Annual Rates per 1,000 Strength with Relative and Comparative Rates

Source: Hollerith Tabulations

1. Annual Rates per1,000 Strength| 1940 1941 1942 1943 1944 1945 | Averages

Gonorrhoea 6°35 8-84 | 11-27 8 5-08 8-85 8-07
Syphilis FS @ a . 0:89 1'4t 2°45 2°8i 2°42 31s 2°20
Soft Chancre . 0:04 | 0°06 0-0. 0-03 003 o-02 0-04
Other Causes and Unspecified | o-12 o-19 or 0°32 117 1-12 0°52
Totals . ‘ s é. 7°40 10°50 13°94 11°27 8-70 13°14 10°83
Percentages of voel aiituissions
for diseases 7 10 10 8 7 9 8
2, Relative Rates
Gonorrhoea 85-81 | 84-19 | 80°8. 71°34 | 58°39 | 67°35 | 74°52
yphilis + | 12-03 | 13°43) | 1775: 25°55 | 27°82 | 23°97 | 20°31
Soft Chancre . O54 0:97 0°29 0°27 O34 Orls 0°37
Other Causes and Unspecified | 1°62 “Br 1°29 2°84 | 13°45 8-52 4°80

Totals . * . . 100 100 100 100 100 100 100

3. Comparative Rates (1943 = 100)

Gonorrhoea 79 110 140 100 63 110
Syphilis ‘ « “ 31 49 100 84 109
Soft Chancre . 13. 200 13 100 100 67
Other Causes and Unspecified : 3 59 5! 100 366 350

Totals 3 ‘ ‘ « 66 93 124 100 77 117

DISEASES OF THE GENITO-URINARY SYSTEM

Admissions for this group of diseases showed a steady increase,
interrupted by a very slight decline only in 1944, from an initial rate
of 4 in 1940 to 10 in 1945 with an average of 6 per 1,000. In 1944 they
were very slightly lower (by 0-05 per 1,000) than those in 1943, but 1945
admissions recorded an increase of nearly 3 per 1,000. They were
between four and seven per cent. of all admissions for disease, averaging
at five per cent. The tables on page 120 analyse the admissions.

Over seventy per cent. of the admissions in this group were caused by
Diseases of the ORGANS OF GENERATION. Recorded admissions of this
sub-group increased annually from under 3 in 1940 to 5 in 1943 and
finally to between 7 and 8 per 1,000 in 1945, with an average of 4-7
which represented over three per cent. of all admissions for disease.
Of the average of nearly 5 per 1,000 in the sub-group, N.V. URETHRITIS
was responsible for sixty per cent. Admissions climbed from 0-76 in
1940 to 3-92 in 1945, a range of slightly over 3. The growing numerical
importance of this disease is emphasised by its relative rates within the
group, which increased from 19 to 39 per cent. over the six years.

Admissions for N.V. EPIDIDYMITIS also recorded increases over the
period, the rateof 0-84 in 1945 being six times that in 1940. Increases in

120 CASUALTIES AND MEDICAL STATISTICS

Annual Rates per 1,000 rei ret dt Relative and Comparative Rates

Source: Hollerith Tabulations

United Kingdom, 1940-45
Admissions to Hospitals for: Diss Diseases of ithe Genito-Urinary System

Annual Rates per 1,000 Strength} 1940 1941 1942 1943 1944 1945 | Averages
Diseases of the eis
Pyelitis . 0-18 0°07 o18 0°27 o-22 0°26 0°20
Renal Colic” 5 ong ors 016 0-16 o-17 0-26 O17
Others « 0°34 0°30 0-40 0-48 O51 o-75 0°46
Diseases of the Ureter 0°04 0°05 0°05 0-05 0-07 0-09 0°06
Diseases of ladder:
Cystitis 026 0°30 “39 0°46 0°42 S38 o°37
Others 0-03 0°04 0-06 0-07 0-07 o 0°06
Urinary Disorders 0°32 0°40 o's 0°62 o-ss 0°56 0°50
Diseases of the Organs of
Generation:
Balanitis, N.V. . 0°56 ovor 0°63 o-st 0-35 oso | 0-44
Urethritis, N. ‘ 0°76 1°20 1°68 1°78 2:38 3°92 1°95
: 0-02 | 0-05 0:06 | 0:06 | 0:06 | o-15 0-07
i 0-25 ovat 0°26 0-22 oro | o-rs 0°20
0°23 0°23 0°35 0°38 0°32 0°36 o-31
i 0:06 | o-05 0-09 | o-rr o-og | org 0-09
Epididymitis, N. omg | o-rg 0°42 0-54 0°50 0-84 0°45
Paraphimosis 0°07 o-12 o-2r O18 o-18 0°27 O-17
Phimosis 0°20 0°30 o°52 o's4 0°42 oss o°42
Others 0-35 o-41 0°68 0-70 0-58 056 oss
Totals 3°95 4°03 6°72 7°13 7°08 9°92 6°47
Paces es of total admissions
iseases 4 4 5 5 5 % 5
2. Relative Rates
Diseases of the Kidneys:
Pyelitis 4°67 1°83 2°63 3°76 3:0 266 3°09
Renal Colic “49 3°80 2°37 2-27 2-3! 2°66 2-63
Others *S7 7°48 5°98 6°69 7:22 7°53 74
Diseases of the | Ureter 0-97 119 0°76 o-70 0°94 0-92 0°93
Diseases of the Blodder:
Cystitis 6-60 7°36 5°72 6-39 5°94 3°95 5°72
Others ¥ 0°69 1°07 0°94 0°90 1°03 0-83 0-93
Urinary Disorders | 8:15 | 10-01 8°56 8-71 7:79 5°60 7°73
Diseases of the Orage of
. 14°15 0°33 9°42 4°92 97 6-80
: 19°29 | 29°87 | 25-07 33°6. 39°49 | 30°14
Z c O°52 0°98 0°87 0-8 1°47 1-08
Varicocele . . 6-22 5:09 3°80 1°45 1°56 3709
Hydrocele . 5°94 3:7 5:21 4°87 3°67 | 4:79
NV... 1°62 1-28 1°35 1°26 1°38 1°39
Epididym: Ve ¥ 3°46 3°54 6°29 8-39 8-45 6-905
Paraphimosis . . z3S 2-34 3°10 2°47 2°75 2°63
Phimosis Z : #35 7°48 779 “89 sat 6-49
Others 96 10°07 10°14 ar Ss" 8-50
Totals . . 100 100 100 100 100 100 100
3. Compunitie Rated (1548 = 100)
Diseases of the Acscneyss
Pyelitis 6 26 67 100 81 06
Renal Colic 8 4 100 100 106 16,
Others 7 3 83 100 106 i
Diseases of the Ureter 80 100 100 100 140 180
Diseases of the Bier!
Cystitis ° . 57 65 8. 100 or 85
len sig sige : 43 37 8 100 190 114
'rinary Disorders . 52 5 94 100 9 90
Diseases of the Organs of ”
Generation:
Balanitis, NO 110 2 124 100 69 116
Urethriti 43 67 o4 100 134 220
Prostatiti 33 83 100 100 100 250
Varicocele 14 9s | 18 | 100 45 és
Hydrocele 61 6r 92 100 84 95
rchiti 5: 4 82 100 82 127
Epididym 2 2 78 100 109 156
Paraphimosis 39 67 117 100 100 150
Phimosis . 37 56 100 78 102
Others 7 “ 50 59 97 100 83 Bo
Totals : : 55 57 94 100 99 139

biatizea ty GOORTe

THE ARMY MEDICAL SERVICES 121

admissions on account of N.V. BALANITIS from 1941 to 1945 were also
recorded when rates rose from 0-o1 to 0-59. This increase, however,
was offset by admissions in 1940, which recorded 0-56 per 1,000,
slightly under the peak rate in 1945. N.V. ORCHITIS was responsible for
low rates of admissions which fluctuated from 0-05 in 1941 to 0-14 in
1945. Steady increases in admissions on account of diseases in this sub-
group were also registered by:

PHIMOSIS from 0:20 in 1940 to 0°55 in 1945
HYDROCELE _ from 0°23 in 1940 to 0°36 in 1945
PARAPHIMOSIS from 0-07 in 1940 to 0-27 in 1945
PROSTATITIS from 0-02 in 1940 to 0-15 in 1945
In only one instance did admission rates decline. This was for VARICOCELE
where admissions ranging from 0-10 to 0:26 fluctuated from 0-25 in
1940 to 0-15 in 1945.

Diseases of the KIDNEY accounted for admissions which averaged 0-8
per 1,000 over the six years. Of these, PYELITIS was responsible for one
quarter and RENAL COLIC for slightly less. Both diseases followed the
general trend of admissions for the group by recording increasing rates
of admissions.

Diseases of the BLADDER caused admission rates at 0-43 per 1,000. Of
this cysTITIS was responsible for nearly ninety per cent. at rates which
commenced at 0-26 in 1940, increased to 0-46 in 1943 and declined to

0-39 in 1945.

MENTAL DISEASES

Admissions on account of Mental Diseases, only a comparatively few
of which were treated in E.M.S. hospitals, followed the trend exhibited
by several individual and groups of diseases in recording rates which
increased annually to 1943, declined in the following year and increased
again in 1945. Rates for this group, which averaged five per cent. of all
admissions for disease, commenced at under 4, increased to 8 by 1943,
fell to slightly under 7 and finally, in 1945, reached 8 per 1,000. The
average rate of admissions over the six years was 6 per 1,000. The tables
on page 122 analyse these admissions.

Nearly three-quarters of the admissions in this group were caused by
PSYCHONEUROSES, admissions for which naturally followed the pattern of
the whole group with increasing annual rates, except in 1944 when there
was a small diminution. Recorded rates were 2-4 in 1940 rising to 6 in
1943, 5 in 1944 and 6-6 in the final year of the period with an average of
4°6 per 1,000. They represented some sixty to eighty per cent. of all
group admissions.

In this sub-group, admissions on account of ANXIETY STATE were by far
the more numerous comprising over sixty per cent. of the total. Apart

122 CASUALTIES AND MEDICAL STATISTICS

Admissions to Hospitals for Mental Diseases. British Troops, Male

United Kingdom, 1940-45

Annual Rates per 1,000 Strength with Relative and Comparative Rates

Source: Hollerith Tabulations

1. Annual Rates per1,000 Strength) 1940 1943 1944 1945 | Averages
Paychoses:

Aanic Depressive 0°26 0°49 0-28 0°24 0°36
Schizophrenia 0-23 0°39 0°49 0°38 O35
Paranoid State 0:03 0°04 0-02 o-or 0°03
Others 0-02 0-02 0-02 0°03 0-02

Psychoneuroses:
Anxiety State 1°29 3°76 3°45 4°89 2-85
Hysteria 0°66 1°96 1°47 144 1°33
Others f & 2 o'4s, 0°35 o-2r 0°27 0-39

Psychopathic Personality | 0°32 o-Br 0-80 | 0-70 | 0-65

Mental Deficiency . & 0°30 es O13 0°08 O-17

Other Mental Diseases 0°03 oO oor o-or 0-03
Totals 3°59 8-03 | 6:89 | 8-05 | 6-18

4 : | 3 s 5 s 5
2. Relative Rates
Ps inset , . 5
lanic Depressive 124 +15 4°10 2:9. 5°82

Schizophrenia 3: 7 4°85 | 7-09 | 4:7 5°66
Paranoid State 0-85 0-44 | 0°33 | o-nr 0-49
Others 0-6) os 0-25 0°34 0°32

Psychoneuroses:
Anxiety State 35°83 46°86 50°04 60°70 | 46-12
Hysteria 18-25 24°40 21 38 17°89 21-52
Others | ¥ 12°65 4:42 3° +40 | 6°31

Psychopathic Personality . 8-94 10°12 11°64 “73 10°52

Mental Deficiency . 8-25 1°88 1°93 102 | 2°75

Other Mental Diseases o-9r 0-73 | 0-18 ovr 0°49
Totals 100 100 100 100 100 100 100

3. Comparative Rates(1943 = 100)

Psychoses:

janic Depressive . . 53 65 114 100 57 49
Schizophrenia.) b0 72 87 100 126 97
Paranoid State : . 75 75 7s 100 so as
Others ‘ - « . 10° 100 100 100 100 150

Psychoneuroses:
Anxiety State . 34 35 64 100 92 130

ysteria . 34 42 100 5 73

Others. 5 . 129 17 18 100 rs q7
Psychopathic Personalit Z 40 65 9s 100 9 86
Mental Deficiency 200 120 120 100 7 53
Other Mental Diseases ‘50 33 33 100 17 7

Totals 45 49 82 100 86 100

from the slight decline in 1944, rates increased annually from 1-3 per
1,000 in 1940 to 49 in 1945, and were forty-six per cent. of the group
total. Admissions due to HYSTERIA followed a slightly different trend,
commencing at 0-7 in 1940, increasing annually to 2 in 1943, followed
by a decline in each of the following years to 1-4 in 1945. The average
rate over the six years was 1-3 per 1,000, representing twenty-two per

cent. of all admissions for the group.

PSYCHOSES were the cause of approximately one-sixth of the admissions
for Psychoneuroses and twelve per cent. of the whole group. Those for
MANIC DEPRESSIVE state were only very slightly more numerous than

THE ARMY MEDICAL SERVICES 123

were admissions for Schizophrenia, and reached a peak of 0-6 in 1942
(from 0-3 in 1940) before declining to 0-2 in 1945. Admissions for
SCHIZOPHRENIA increased each year from 0-2 in 1940 to a peak of 0-5 in
1944. The rate in 1945 was slightly less than that in 1944 at 0-4 per
1,000.

PSYCHOPATHIC PERSONALITY produced admissions at rates which
increased annually from 0-3 in 1940 to 0-8 in 1943 and 1944, declining
to o-7 in the final year. The average rate of 0-65 per 1,000 was some ten
per cent. that of the whole group. Admissions due to MENTAL DEFICIENCY
were at variance with the general trend of the group as a whole in that
they declined year by year. Rates fell from 0-30 in 1940 to 0-08 in 1945,
with an average of a little under 0-2 per 1,000.

DISEASES OF THE RESPIRATORY SYSTEM

This group of diseases was responsible for admission rates which
varied from 4°95 in 1941 to a peak of 6-59 in 1943 with an average rate
of 5-7 per 1,000. As percentages of admissions for all diseases, the rates

United Kingdom, 1940-45

Admissions to Hospitals for Diseases of the Respiratory System. British Troops, Male
Annual Rates per 1,000 Strength with Relative and Comparative Rates

Source: Hollerith Tabulations

1. Annual Rates per1,000 Strength| 1940 1941 1942 1943 1944 1945 | Averages

Bronchitis:
Acute a a F - | mar 0°84 1:02 e 3u 0°87 1:00
Chronic. . . . 0:87 o-8r 1°22 Us 0°95 108
Unspecified ¥ ¥ « 2°48 1°89 1°87 i I'4t 182
Asthma # rs s 35 o-4r 0°43 0-69 e 53 0°62 0-52
Pleurisy ; > | 9:49 | 042 | 0-50 | 0°84 0-70 | 0-52
Other Causes ” : - | 0°86 0-58 0°54 o 0°83 o-74
Totals + + + + | 6290 | 495 | 5°83 | 6:50 | S00 | 5°38 | 5-68
Percentages of total admissions
for es 3 -| 6 s 4 4 4 4 4
2. Relative Rates
Bronchitis:
Acute . . . « | 19°20 | 16-89 17°48 19°9) 14°56 | 16-24 | 17°61
Chronic . . . « | 13°86 16°46 20°9; 21-9 23°17 1760 19°02
Waspectieg) . * » | 38-98 38-25 398 28°57 28-12 26°23 32°04
Asthma . : - | 6-50 8-65 1r-75 97 9°26 | 11-50 ors
Pleurisy 2 LL | aBz | 798 | 8-64 -15 | 10°33 | 13-03 ors
Other Causes” * . - | 13°s9 11-79 9:22 13°40 14°56 15°40 13°03
Tos . . . «| 100 100 100 100 | 100 100 100
3. Comparative Rates(1943 = 100)
Bronchitis:
Acute. we Md “Bs 96 8s 88 100 3 8:
Chronic 2 FLL 63 75 95 100 106 80
Unspecified ae see 136 134 112 100 98 92
Asthma. . . . . 77. t 130 100 87 117
leurisy - 2 2 a or 4 93 100 130
Other Causes . . < 98 66 or 100 3 oF
Totals . . 5s 9s 75 88 100 76 82

5*cMS

124 CASUALTIES AND MEDICAL STATISTICS

ranged from 3:5 to 6 per cent. The general tendency of these relative
rates was to decline annually from the peak of 6 in 1940 to 3-5 in 1945.
This was in distinct contrast to the rates per 1,000 which displayed
undulating annual variations not in common with the majority of the
diseases tabulated. An opening rate of 6-3 in 1940 was followed by a fall
to 5 in 1941. Then two annual increments brought the rate to its peak of
6-6 in 1943. The rate in 1944 was less than in the previous year at 5,
but another increase in 1945 raised the rate to 5-4 per 1,000. An analysis
of admissions for the group is given on page 123.

Admissions due to BRONCHITIS were responsible for from sixty to over
seventy per cent. of the total for Respiratory Diseases, being heaviest in
1940 and 1941 and declining annually during the following years. They
varied from 3-3 to 4:6 per 1,000, the higher rates being experienced in
1940, 1942 and 1943. ACUTE Bronchitis recorded admissions which,
averaging at I per 1,000, were one-quarter of the total for Bronchitis.
Those for CHRONIC cases were only very slightly higher, while
UNSPECIFIED Bronchitis registered the remainder at a little less than half
the total.

ASTHMA and PLEuRIsyY recorded identical average rates at 0-5 per 1,000,
approximately ten per cent. of the total for the group. Rates for the
former ranged from 0-4 in 1940 to a peak of 0-7 in 1942 with a final rate
of 0:6. Those for Pleurisy exhibited an almost similar range varying
from 0-4 in 1941 to 0-7 in 1945.

SCABIES
Next in numerical importance were admissions for Scabies, rates for
which are listed below.

United Kingdom, 1940-45
Rates of Admissions to Hospitals for Scabies. British Troops, Male
Source: Hollerith Tabulations

1940 1941 1942 1943 1944 1945 | Averages

Rates per 1,000 Strength’ . 9-3 11°37 7:82 r10 o-7r 100 5
Comparative Rates é 338 1,034 71 100 65 or _

Pescencages of) of sozal Guinan
a" 6 1 1 1 4

Admissions were conspicuous for their dramatic decline from rates
which were comparatively high in the first three years at 9, 11 and 8
per 1,000 respectively to 1 per 1,000 in each of the years 1943 to 1945.
From being eleven per cent. of all admissions for disease in 1941, they
registered slightly over one-half per cent. in 1945. In no other disease
or group of diseases did admissions to hospitals in the United Kingdom
exhibit such a remarkable decline.

THE ARMY MEDICAL SERVICES 125

DISEASES OF THE AREOLAR TISSUE

Admissions on account of Diseases of the Areolar Tissue varied from
28 in 1941 to 5°5 in 1943 with an average of 4 per 1,000. They consti-
tuted between three and four per cent. of all admissions for disease. In
1944 they were just over eighty per cent. of those recorded in 1943, while
in 1945 they were ninety-four per cent. The tables below analyse the
admissions.

United Kingdom, 1940-45

Admissions to Hospitals for Disease of the Areolar Tissue. British Troops, Male
Annual Rates per 1,000 Strength with Relative and Comparative Rates

Source: Hollerith Tabulations

1. Annual Rates per 1,000 Strength} 1940 1941 1942 1943 1944 1945 | Averages
Cellulitis 2°46 a4 2°64 4°08 3°13 3°s2 2°99
Benign and Unspecified Tumours

and Cysts 0-04 0:06 o-14 | 0°17 | 0-20 0-29 | or
Crspecihed Abscesses 0-50 | 0-60 1-or 1-25 117 1°33 | 0-9)
Other Causes . 0°00 0°00 o-or o-o1 o-or 0°03 o-or

Totals 3:00 2°80 3°80 S's 4st S17 4°13
Percentages of total admissions

for diseases Saeed) tor 3 3 4 4 3 3

2. Relative Rates
Cellulitis 3 81-88 | 76-so | 69°37 | 73°95 | 69°37 | 68-08 | 72-40
Benign and Unspecified Tumours

and Cysts x - | aa 2°13 3:70 3:08 + 5°64 3°63
Unspecified Abscesses | ~ | 16-71 aren? 26° 22°72 25°9' 25°75 23°73
Other Causes : Fy - | Orr or 0°24 0°24 o-2r 0°53 0°24

Totals € . . + | 100 100 100 100 100 100 100
3. Comparative Rates(1943 = 100)
Cellulitis é 60 2 65 100 77 86
Benign and Unspecified Tumours

and Cysts ‘ 24 3 83 100 118 171
Unspecified A Abscesses | ‘ 40 4 81 100 94 106
Other Cai . 23 27 17 100 59 260

Totals 4 o . : 54 st 69 100 82 94

Between seventy and eighty per cent. of the admissions of this group
were on account of CELLULITIS, rates for which fluctuated between 2 and
4 per 1,000. The highest rate of admission occurred in 1943 followed by
3:1 and 3-5 respectively in 1944 and 1945. The average rate over the
six years was 3 per 1,000.

Unspecified ABSCESSES accounted for nearly one quarter of all
admissions for this group. Rates increased annually from 0-5 in 1940
to 1-3 in 1945 and averaged at very slightly under 1 per 1,000.

Rates for Benign and Unspecified TUMoURs and Cysts increased each
year from 0-04 in 1940 to 0-29 in 1945. They represented, on the
average, under four per cent. of all admissions for the group. Admissions

1246 CASUALTIES AND MEDICAL STATISTICS

for Malignant Tumours and Cysts, which are included in ‘Other causes’
were very few, being some four per cent. only of the Benign and
Unspecified types.

DISEASES OF THE CARDIO-VASCULAR SYSTEM

Admissions for this group of diseases were noticeable, in 1942, for
the increase by over one hundred per cent., at 5-7, of those on the pre-
vious year (2-48 per 1,000). They then declined during the next two
years to 3-7 in 1944, but increased to 4-7 in 1945. Admissions over the
six years were equivalent to an average rate of 4 per 1,000 and are
analysed in the tables presented below.

United Kingdom, 1940-45

Admissions to Hospitals for Diseases of the Cardio-Vascular System. British Troops, Male
Annual Rates per 1,000 Strength with Relative and Comparative Rates

Source: Hollerith Tabulations

1. Annual Rates pert,ooo Strength} 1940 1941 1942 1943 1944 1945 | Averages
Valvular Disease of the Heart . | 0-17 | 0:10 | 0-95 | 0°13 | 0°06 | 0-06 9-34
Varicose Veins : -| EB 1-75 3°84 3°97 2°69 3°59 28
Other Causes . . * oO 0°63 0-95 1°09 o-o1 102 o-or

Totals a P a - | 2°36 2°48 5°74 S19 3°66 4°67 4°08

Percentages of total admissions
for diseases. 2 2 4 4 3 3 3

2. Relative Rates

Valvular Disease of the Heart . 7°20 4°03 16°55 2°51 1°64 129 5°99

Varicose Veins ‘i « | 56°36 70°S7 66-90 76°49 73°50 76°87 71°32

Other Causes . . . « | 36°44 25°40 16°55 a1'00 24°86 21°84 | 22°69
Totals . . . + | 100 100 100 100 100 100 100

3. Comparative Rates (1943 = 100)

Valvular Disease of the Heart . 131 17 731 100 46 46

Varicose Veins $ S 34 4 17 100 68 9°

Other Causes . : . . 79 s' 7 100 83 4
cn a es 45 48 [am 100 n 90

By far the majority (seventy per cent.) of admissions in the group
was caused by VARICOSE VEINS, rates for which increased from 1-3 in 1940
to 4 in 1943 before subsiding to 3-6 in 1945. The largest increase in
admissions occurred in 1942 when a rate of 3-8 was recorded, some 2 per
1,000 in excess of admissions in 1941. The average rate was 2-9 per
1,000.

A comparatively large increase in admissions occurred in 1942 on
account of VALVULAR DISEASE of the HEART. A rate of 0-10 in 1941 rose to
0°95 in the following year. This was followed by 0-13 in 1943 and 0-06
per 1,000 in both 1944 and 1945.

THE ARMY MEDICAL SERVICES 127

MALARIA

Admissions for Malaria were remarkable for the dramatic increase in
1944. During 1940 and 1941 recorded cases produced rates of 0:08 and
0-07 respectively. In 1942 admissions increased to 0-21 and the follow-
ing year witnessed a further rise to 0-54. In 1944 they were so numerous
as to increase the rate to nearly 10 per 1,000. This was followed in 1945
by a twenty-five per cent. decrease to 7 per 1,000. Much of the increase
can only be attributed to relapses occurring among troops returning to
the United Kingdom from the Middle East and North Africa. Un-
fortunately, it is not possible to produce figures to support this hypo-
thesis as the coding of Malaria for statistical purposesdid not distinguish
between fresh and relapse cases. Admissions are analysed in the tables
below.

United Kingdom, 1940-45

Admissions to Hospitals for Malaria. British Troops, Males
Annual Rates per 1,000 Strength with Relative and Comparative Rates

Source: Hollerith Tabulations

1. Annual Rates per 1,000 Strength| 1940 1941 1942 1943 1944 1945 | Averages
Malaria:
Benign Tertian . | 0-02 | o-or o-oz | ot8 | 6-73 | 4:17 1-86
Sub-Tertian . . . 0-00 o-or 0°06 0-09 o-13 0°07 0°06
Others and Unspecified 0-06 0-05 0°13 0:27 2-77 2-80 ror
Totals = : : . 0°08 0°07 ovat 0°54 9°63 7:04 2°93
Percentages of total admissions
r diseases: ig . our or oz o4 7 5 2
2. Relative Rates
Malaria:
Benign Tertian . . « | 21°62 | 12-60 | 11°89 | 34:20 | 69-92 | so-z5s | 63°48
Sub-Tertian ae ~ | 7724 15°75 | 27°91 17°55 1°39 1°03 2°05
Others and Unspecified = | | 71-17 | 71-65 | 60-20 | 48-25 | 28-69 | 30-72 | 34°47
Totals : . . + | 100 100 100 100 100 100 100
3. Comparative Rates(1943 = 100)
Malaria:
Benign Tertian 2 | " 6 1"
Sub-Tertian 1) 5 1 67
Others and Unspecified $ 22 19 a
Totals

Admissions for BENIGN TERTIAN Malaria were over sixty per cent. of all
admissions in this group and, naturally, tended to conform to its overall
pattern of admissions by increases from 0-02 in 1940 to 0°18 in 1943,
followed by an exceptionally large rise to 6-7 with 4-2 as the rate in
1945.

Cases of SUB-TERTIAN Malaria produced rates which increased from
0-00 in 1940 to 0-13 in 1944 and declined to 0-07 in 1945. ‘Others and

128 CASUALTIES AND MEDICAL STATISTICS

Unspecified Malaria’ comprise on the average over one-third of all
Malaria admissions and include the following:

QUARTAN Malaria —3 cases in 1942, 8 in 1943 and 32 in 1944
OVALE —1 case in 1941, 1942 and 1944, and 3 cases in 1943.
BLACKWATER FEVER—7 Cases in 1941, 9 in 1942, and 5 in 1943.

Most of these numbers are so small that they would be shown as 0-00
per 1,000 if entered in the tabulations.

COMMON COLD

Following Malaria in numerical importance came admissions for
Common Cold, rates for which are tabled hereunder.

United Kingdom, 1940-45
Admissions to Hospitals for Common Cold. British Troops, Male

Source: Hollerith Tabutations

1943 | 1944 | 1945 | Averages
412 | 1-36 | 1-82
too | 33 44

Rates per 1,000 Strength .

2°45
Comparative Rates —

Percentages of total admissions
for diseases. . . 2

Admissions during the six years were erratic, increasing and decreas-
ing in alternate years. The rate in 1940 was 2-6; in 1941 it had increased
to 2°8, but during 1942 fell to 2-0. A hundred per cent. increase in 1943
brought the rate to slightly over 4 per 1,000. During the following year
it fell to 1-4 but increased again in 1945 to 1-8. The average rate was
slightly under 2-5 per 1,000. Admissions in 1941 and 1943 were three
per cent. and in 1942, 1944 and 1945 one per cent. of all admissions for
diseases.

DISEASES OF THE NERVOUS SYSTEM

Nearly two per cent. of all admissions for disease were attributable
to Diseases of the Nervous System. Admissions fluctuated between 1-9
in 1941 and 2-8 in 1943, culminating in the slightly lower rate of 2-75
in 1945. The average over the period was 2-4 per 1,000. Tabulations
showing analysis of admissions for this group are given on page 129.

Admissions on account of SCIATICA were more numerous than other
causes within the group. Over the six years they averaged 0-76 per
1,000 and were approximately one-third of all the admissions for the
group. Rates, which were higher during the last three years, commenced
at 0-4 in 1940, rose to 1-0 by 1943 and remained comparatively stable
during the next two years. Other cases of NEURITIS produced rates which
were fairly steady, ranging from 0-11 to 0-16 per 1,000.

THE ARMY MEDICAL SERVICES 129

United Kingdom, 1940-45

Admissions to Hospitals for Diseases of the Nervous System. British Troops, Male
Annual Rates per 1,000 Strength with Relative and Comparative Rates

Source: Hollerith Tabulations

1. Annual Rates per 1,000 Strength] 1940 1941 1942 1943 1944 1945 | Averages

Sciatica 0°43 0-43 0-73 1-00 0°98 1-or 0°76
Other Neuritis ory or org 0°16 on1g og og
M ine oO" 0-09 orrz ou On or ovr
Epi 0'49 0°31 0-30 or2 0-22 o-2 o-3r
Other Diseases of Uncertain
Pathology a 0-05 0-08 0-09 0°06 or 0-08
‘ffort Syndrome 0°27 0°34 0-30 0-16 ovr 0-25
Diseases of Cerebral Meninges - 0°07 00g | 0°06 | 0-08 | o-rr 0-0
f Brain 0°07 0:07 0-06 0709 orr4 o-ol
Disorders of Cranial Nerves 0-22 0-40 | 0-46 | 0°30 | 0-3 0°35
Other Causes 0°20 0-34 0:27 0°23 o-2 0°23
Totals : : 5 - | 2-02 1°90 2°47 2°80 2°38 2-75 2°38
Rercentages of total admissions
for diseases. . 2 2 2 2 2 2 2
2. Relative Rates
Sciatica “i . - | 21°33 | 22°66 | 29°53 | 35° 41's: 36°75 | 31°
Other Neuritis : - | 6-85 5°86 3.33 5-86 6's) 4°97 5-88
Mi ins BEA Peo 6 80: 459 | 4:97 | sc2 3:48 5°63 | 4:62
pil 24°49 | 16-41 | 12-30 | ovr O18 9:27 | 13-03
ieee 8 "Diseases of Uncertain é x " ‘
athology . 2°47 au 3° 3°32 2°57 Ss" 3:3!
Effort Syndrome 13°41 14°38 13°7 10°63 6-89 5°90 10°51
Diseases of Cerebral Meninges | 3°30 21 1-7! 2°32 3°54 3:97 2°9.
Diseases of Brain a 358 32 2°65 2°26 3°73 4:97 3-3!
jers of Cranial Nerves + | To" 18-20 | 16-25 | 16°37 | 12-97 | 13°58 | 14°71
Other Causes “ . | 10-08 10°35 9°ss 9°58 9°56 9°27 9
Totals . . . + | 100 100 100 100 100 100 100
3. Comparative Rates(1943 = 100)
Sciatica A ‘ 7 4 3 73 100 98 101
Other Neuritis : at « 8 re 3 100 94 88
Mig . Y % 64 100 7 107
1 119 ceed 100 5S 100
Other Diseases of Uncertain
Elion Sore 56 4 89 100 67 167
90 go 113, 100 53 3
Bacneee of Covet Cerebral Meninges | 117 67 67 100 133 183
of Brain ‘e ur 100 17 100 150 233
Disorders of Cranial Nerves 5 3 76 87 100 5 12:
Other Causes . : 4 4 89 100 85 38
Told a i ke 68 88 | 100 | 4 98

DISORDERS of CRANIAL NERVES accounted for an average rate of 0-35
per 1,000. Admissions increased from 0-2 in 1940 to nearly 0-5 in 1943,
declined to 0-3 and increased to slightly under 0-4 in 1945. The trend of
admissions for EPILEPSY was somewhat different in that rates decreased
annually from 0-5 in 1940 to 0:2 in 1944. The rate in 1945 at 0-26 was
identical to that recorded in 1943.

Admissions through EFFORT SYNDROME recorded identical rates in 1940
and 1941 at under 0-3 per 1,000. They rose slightly in 1942 and 1943
and, in 1944 and 1945, were again identical at under 0-2. The average
rate was 0°25 per 1,000.

1430 CASUALTIES AND MEDICAL STATISTICS

Other causes, admissions for which increased over the six years under
review were:

MIGRAINE which rose from 0-08 in 1940 to 0-15 in 1945
DISEASE of the BRAIN which rose from 0-07 in 1940 to 0-14 in 1945

DISEASE of the CEREBRAL MENINGES
which rose from 0:07 in 1940 to 0-11 in 1945.

PNEUMONIA

Admissions for Pneumonia were responsible for rates which averaged
over 2 per 1,000, equivalent to one and three-quarters per cent. of all
admissions for disease. Apart from 1944, when there was a small decline,
increases were experienced each year. Rates commenced at 0°85 in 1940
and ended at 3-89 per 1,000 in 1945. They are analysed in the tables
below.

United Kingdom, 1940-45
Admissions to Hospitals for Pneumonia. British Troops, Male
Annual Rates per 1,000 Strength with Relative and Comparative Rates

Source: Hollerith Tabulations

1, Annual Rates per 1,000 Strength 1940 1941 1942 1943 1944 1945 | Averages
Pneumonia:
Lobar “ iat . | 0726 0°36 o-8r 1-01 0°87 145 0-79
Broncho-Pneumonia . . 0°27 0°37 0°42 0°43 o'35 o's3 0°40
Pneumonitis * : 0-02 o'10 0°32 0°57 0°52 o'77 0°38
Unspecified : : :} 0-30 | 0-29 | 0-60 0-79 0°90 rg | 0-67
Totals s FI i F 0-85 mera 2-1s 2-80 2°64 3°89 2°24
Percentages of total admissions
for diseases i fot r 2 2 2 3 2
2. Relative Rates
Pneumonia:
bar 5 Saul ge + | 30°80 | 31-78 | 37°43 | 36-01 | 33-21 | 37°23, | 35°37
Broncho-Pneumonia » | 31°57 3g te 19°74 15°38 13°26 13°82 17°86
Pneumonitis sf | 2:85 86 | 14°98 | 20°46 | 19-8 19°67 | 16-96
Unspecified . . - | 34°98 26°26 27°85 28-15 33°7 29°28 29°91
Totals . . . + | 100 100 100 100 100 100 100

3. Comparative Rates(1943 = 100)

Pneumonia:
bar 7 Steeles? S 26 6 80 100 86 144
Proncho-Pneumonia_. . 63 6 98 100 81 123
Pneumonitis x 2 = 4 18 56 100 91 135
Unspecified “ : ¥ 38 37 76 100 114 144
Totals $ . . . 30 40 77 100 94 139

One third of all the cases in this group were attributable to LOBAR
PNEUMONIA. Admission rates increased from 0-26 in 1940 to I-or in
1943, declined to 0-87 during the following year, then increased to 1°45
in 1945. The average rate was 0-79 per 1,000,

BRONCHO-PNEUMONIA was responsible for a similar trend in admissions
although increases were not so sharp. Rates began at 0-27, rose to 0°43

THE ARMY MEDICAL SERVICES 131

by 1943, fell slightly to 0-35 and increased to 0°53 in 1945. The average
rate of o-4 was one-half that for Lobar Pneumonia.

The average admission rate for PNEUMONITIS at 0-38 was only very
slightly less than that for Broncho-Pneumonia but the rate of increase
from 1940 to 1945 was much more pronounced in the former which
began at 0-02 and ended at 0-77, a range of 0-75 as compared with 0-26
for Broncho-Pneumonia.

DISEASES OF THE MOUTH, TEETH AND GUMS

Admissions to hospitals for this group of diseases, on the average,
were slightly less than those for Pneumonia. Recorded rates, which
varied from 1-5 to 2-8 per 1,000, increased annually to the peak rate
in 1942, declined in each of the two following years, then rose in the
final year to the rate which obtained in 1941. The average rate of
admissions was 2-2 per 1,000 representing two per cent. of all admissions
for disease. In the tables which follow the rates for the group are
recorded.

United Kingdom, 1940-45

Admissions to Hospitals for Diseases of the Mouth, Teeth and Gums
British Troops, Male
Annual Rates per 1,000 Strength with Relative and Comparative Rates

Source: Hollerith Tabulations

1. Annual Rates pert,ooo Strength} 1940 1941 1942 1943 1944 1945 | Averages
Diseases of the Mouth:
Stomatitis. . > 0:06 0-18 0°13 0°08 or10 0°05 o-10
Sincent’s Angina” # o-71 0°87 rig 1°23 0°65 0°82 0-90
Others 5 o-or oor o-or 0-02 o'or 0-02 o-or
Diseases of the Teeth:
Dental Caries. : | orm ormz oz og ong O19 Os
Periostitis . i : - | og or7 o-18 0:26 o-13 our O17
hers. 0-32 | 0-42 | 0°56 | o-s2 | 0-54 | 0-81 0°53
Diseases of the Gums:
Gingivitis. . + | e709 0°46 orst o°3r O17 0°23 0°30
Others * * * 3 0°04 0°03 0-05 0°05 0°03 0°03 0°04
Totals » oe ee | egg | 2-26 | a-7s | 2-66 | 1-76 | 2:26 | 2-20
Percentages of all admissions for nt
diseases . 'e ¢ . 1 2 2 2 1 1 2
2. Relative Rates
Diseases of the Mouth:
Stomatitis. . ‘4 4°03 778 4°66 3°08 5°48 2°42 4°84
Sineent’s Angina tl | 45-85 | 38-42 | 4t-s4 | 46°16 | 30-88 | 36-28 | 40-01
Others . . O47 0°44 o'st 0°87 0°64 080 o'4s
Diseases of the Teeth:
tal Caries. * - | 6:55 5°48 6°35 7:18 7:61 8-47 6-82
Periontitia ‘ @ . ~ | 12-25 7°50 6:60 9°76 7°61 4°84 7°73
Others + . . 20°69 18°43 20°19 19°57 30°23 35°89 24°09
Diseases of the Cures
Gingivitis. » «| $60 | 20°46 | 18-45 | 2-40 | 9°74 | 10°08 | 13-64
Others > ff fd 2-56 1°49 1°70 1°98 1°81 1-21 1-82
Totals . . . + | 100 100 100 100 100 100 100

1332, CASUALTIES AND MEDICAL STATISTICS
3. Comparative Rates(1943 = 100)

Diseases of the Mouth:

Stomatitis . A < ‘ 7 225 163 100 125 63
Vincent's Angina . . 3! 7 93 100 53 67
Others ’ . . so 50 5° 100 5° 100
Diseases of the Teeth:
Dental Caries . . 58 63 89 100 68 100
Periostitis . - Ps ri 73 65 69 100 5° aa
: 62 8r 108 100 104 156
Diseases of the Gums: ; .
singivitis . A 29 14! 165 10° 5 ‘4
Others | 8 | “bo | too | too | é
Totals 4 ¥ : he 58 85 103 100 66 85

With an average rate of 1 per 1,000, Diseases of the Mouth were
responsible for forty-five per cent. of all admissions for the group.
Diseases of the Teeth, at 0-85 per 1,000, were responsible for nearly
forty per cent. and Diseases of the Gums, with arate of 0-3, some fifteen
per cent.

Nine-tenths of the admissions for Diseases of the Mouth were
attributable to VINCENT’S ANGINA. Rates rose in three years from 0-7
in 1940 to 1-2 in 1943. In 1944 they fell to just over one-half the peak
rate to 0:65 and increased to 0-8 in 1945. The average rate of 0-9 per
1,000 was some forty per cent. of the total for the group. STOMATITIS
accounted for one-tenth of the admissions for Diseases of the Mouth and
just under five per cent. of all admissions for the group. Rates varied
from 0-05 in 1945 to 0-18 in 1941 with an average of 0-1 per 1,000.

Of admissions for Diseases of the Teeth, PERIOSTITIS accounted for
one-fifth and DENTAL CARIES for slightly less. The former produced rates
averaging at 0-17 per 1,000 and which, apart from a rise to a peak rate
of 0°26 in 1943, declined each year from 0-19 to 0-11 in 1945. The
trend of admissions for Dental Caries was in distinct contrast in that,
apart from a decline in 1944, rates rose from 0-11 in 1940 to 0-19 in
1945 with an average of 0-15 per 1,000.

Nearly ninety per cent. of admissions for Diseases of the Gums were
caused by GINGIVITIS, rates for which increased from 0-1 in 1940 to 0-5
in 1942, declining to 0-2 per 1,000 in 1945 and averaging 0°3 over the
six years.

INFLUENZA

Admission rates for INFLUENZA were distinguished by high rates of
3°4 per 1,000 in both 1940 and 1943 as against an average of 1-1 for the
remaining four years. Rates are given on page 133.

Although the admission rates per 1,000 strength in 1940 and 1943 are
practically identical, expressed as percentages of the total admissions
for disease, the rate in 1940 is greater by one per cent. The average rate
of 1-9 per 1,000 was slightly over one-half of one per cent. of that for all
diseases. Following the high rates of admissions in 1940 and 1943, the

THE ARMY MEDICAL SERVICES 133
United Kingdom, 1940-45
Admissions to Hospitals for Influenza. British Troops, Male
Annual Rates per 1,000 Strength with Comparative Rates
Source: Hollerith Tabulations
1940 1941 1942 1943 1944 1945 | Averages
Annual Rates per 1,000 Strength | 3-47 | 1°48 1-06 | 3°42 1-07 | o-8s 1-89
Percentage of total admissions cad
Diseases . 3 1 1 2 1 I I
Comparative Rates (1943 = 100) | ror rey 31 100 31 25 =

decline in 1941 was some fifty-seven per cent. compared with sixty-nine
per cent. in 1944. It is to be noted that 1943, one of the peak years for
admissions for Influenza experienced also the highest rate for Common
Cold, at 4, against a remaining average of 2 per 1,000.

DISEASES OF THE EYE

The trend of admissions for Diseases of the Eye was that of an annual
increase from 1-2 in 1940 to a peak of 2-1 in 1943, followed by a decline
in each of the two following years to 1-7 in 1945. The average rate of
+7 per 1,000 was some 1-4 per cent. of the total admissions for disease.
Rates analysed according to group components are given below.

United Kingdom, 1940-45
Admissions to Hospitals for Diseases of the Eye. British Troops, Male
Annual Rates per 1,000 Strength with Relative and Comparative Rates
Source: Hollerith Tabulations

1. Annual Rates pert,ooo Strength} 1940 1941 1942 1943 1944 1945 | Averages

Diseases of the Eye:
Conjunctivitis 0°29 0°35 0's4 O°S7 0-4. 0°40 o:48
Keratitis 0742 0°56 0°64 0°67 0°61 0°53 o's
Iritis y 0-06 0°07 oro 0°09 O-vlr 0:06 0:08
Blepharitis 0°07 ovr o-1s org | o-rg ong rey
Other Causes 0°38 0-50 o-6r o°s59 0°48 os! 0-52
Totals 122 1°59 2:04 2°06 1°83 1°70 74

Percentages of total admissions
iseases

ee eee

2. Relative Rates

Diseases of the Eye:

Conjunctivitis 23°33 22-01 26°34 2037 23°92 23°53 24°71
Keratitis 34°42 | 35°06 | 31°42 | 32°44 | 36-06 | 31:02 | 33°33
Ints soz | 4:so | 4°88 | 4:49 | 6-09 3°74 | 4:60
Blepharitis 5:85 7°04 7°40 6-82 7°48 9°09 7°47
Causes 31-3) 31°39 29°90 28-48 26°45 32°62 29°89
Totals 100 100 100 100 100 100 100
3. Comparative Rates(1943 = 100)
Diseases of the Eye:
tis. 51 61 95 100 77 7°
63 84 96 100 99 79
67 8 mt 100 122 67
Blepharitis 50 9 107 100 100 107
Other Causes 64 4 103 100 8r 95
Totals . : . 59 7 99 100 89 83
——

134 CASUALTIES AND MEDICAL STATISTICS

KERATITIS was responsible for one-third of the admissions for this
group, which followed the group pattern by increasing annually to 1943,
following which there was a decline. Rates were 0-4 in 1940, 0°7 in 1943
and 0-5 in 1945 with an average of 0-6 per 1,000, which represented one
third the total for the group.

Admissions for CONJUNCTIVITIS also followed the trend of the group
with admissions ranging from 0-3 in 1940 to 0:6 in 1943 and 0-4 in
1945. The average of 0-4 was one quarter of the group total. Other
admission rates were 0-13 for BLEPHARITIS and 0-08 for IRITIS.

DIPHTHERIA

Admissions on account of DIPHTHERIA resulted in an average annual
rate of 0-44 per 1,000 over the six years, with annual rates ranging from
0°37 in 1940 and 1944 to 0-54 in 1945. Analyses of these admissions are
tabulated below.

United Kingdom, 1940-45

Admissions to Hospitals for Diphtheria. British Troops, Male
Annual Rates per 1,000 Strength and Relative Rates

Source: Hollerith Tabulations

1. Annual Rates per1,000 Strength! 1940 1941 1942 1943 1944 1945 | Averages

0°02 0°03 o-o2 0°03 0°02 0°07 0°03
: ‘ . * a 0-00 0-00 o-or o-00 | 0-02 o-or
Paralysis. = é 5 0:00 0°00 0:00 o-or o-0z 0-°0§ o-or
Unspecified and Others . 0°35 0°44 O-4r 0°39 0°32 0°40 0°39
Totals Fi S . - | 0°37 0-48 0°44 O44 0°37 o°s4 0°44
Percentages of total admissions
for diseases . . . o4 o's o'3 o3 o3 oe o-3
2. Relative Rates
Diphtheria:

‘aucial 4°68 5°58 4°01 7°67 6-18 13°56 6-82
Nasal . : — | O99 1-09 1-95 1°35 "39 2°27
Paralysis. A 2 * 0°97 0°66 0°49 1 5:60 “47 2°27
Unspecified and Others ~ | 94°35 | 92°77. | O4-4r 88-43 | 86-87 | 74°58 | 88-64
Totals . : . + | 100 100 100 100 100 100 100

The majority of the cases recorded above fall within the classification
of ‘Unspecified and Others’. Of ‘Others’, admissions were so few that
inclusion in the tabulation of Annual Rates would have resulted in their
being recorded as ‘0-00’ per 1,000. Such admissions include the
following:

LARYNGEAL I case in 1942, and 2 in 1943.
CUTANEOUS __I case each in 1941 and 1942, 4 in 1943, and 3 in 1944.
GRAVIS I case each in 1940 and 1942.

THE ARMY MEDICAL SERVICES 135

OTHER DISEASES

Although admissions for DYSENTERY accounted for an average of
slightly less than 0-5 per 1,000, they were conspicuous for their steady
increase each year, from 0-03 in 1940 to 1°97 per 1,000 in 1945. In
contrast to this, RUBELLA was responsible for the comparatively high
rate of 4-34 in 1940, as against an average of 0-68 for the remainder of
the period. Only in 1944 and 1945 did admissions reach 1 per 1,000 and
in 1942 it was as low as 0:23.

Admissions for TUBERCULOSIS, in general, registered an increase over
the six years, rates ranging from 1-15 in 1940 to 1:07 in 1942 and 1-67
in 1945. They accounted for one per cent. of all admissions for disease.
Of the average rate of 1-29, PULMONARY Tuberculosis was responsible
for 1-08 per 1,000. Disorders of NUTRITION and METABOLISM also
recorded increasing rates of admission, for 0:17 in 1940 to 0°51 in
1945-

MEASLES recorded rates which declined from 0-6 in 1940 to 0-2 in
1942, increased to 0-6 in 1943 before subsiding to 0-4 in 1945. The rate
of admissions for MENINGOCOCCAL INFECTION in 1945 at 0-25 was half
that in 1940, although in 1943 it had declined to the lowest recorded
rate of the period at 0-14.

INJURIES

Admissions for injuries increased from over 5 per 1,000 in 1940 to
nearly 19 in 1943. They declined by 3 in the following year and rose to
just under 18 per 1,000 in 1945. The largest increase in admissions
occurred in 1942 when the rate rose from 6 to 15 per 1,000. This increase
was largely due to the rise of 6-5 in the rate of admissions for injuries
not due to enemy action.

For nearly thirty per cent. of the injuries recorded in the Hollerith
tabulations it is not disclosed whether or not they were caused by enemy
action, as are the remainder. Table 5 records the rates per 1,000 strength
of injuries caused by enemy action (E.A.) and those not so caused
(N.E.A.). It also gives the rates of admissions for injuries for which the
cause was not specified. Assuming that all admissions for injuries were
in the proportions of those indicated in the table each year by E.A. and
N.E.A. injuries, and those unspecified so allocated, rates would be as
indicated on pages 136 and 137.

Table 5 records the rates per 1,000 of admissions for Injuries
classified according to Enemy Action, Non-Enemy Action and Cause
Unspecified. They are further classified as to Head Injuries, Fractures
(other than to the head), Burns, Old Injuries, and Other Injuries. In
Table 6 the information recorded in the previous table has been converted

136 CASUALTIES AND MEDICAL STATISTICS

United Kingdom, 1940-45

Admissions to Hospitals for Injuries
British Troops, Male
Adjusted Annual Rates per 1,000 Strength with Comparative Rates

Source: Hollerith Tabulations

1. Adjusted Annual Rates per 1,000 | Enemy Action | Non-Enemy Action | Totals
Strength

1940 ols 5°29 5°44
1941 orrr 6°33 6°44
1942 O17 15°35 15°52
1943 0°34 18-44 18-78
1944 1°50 14°12 15°62
1945 2°58 15°13 17°71
Averages é 4 0°81 12°44 13°25
2. Comparative Rates (1943 = 100)
1940 Zi c . : . 44 29 39
1941 . . . . : 32 34 34
1942 e i Fy os 50 83 83
1943 . = . . 100 100 100
1944 : * é- 2 ss 441 7 83
1945 - $ 4 ¢ . 759 82 94

to relative rates. A consolidation of these tables giving average rates per
1,000 with relative rates is presented below.

United Kingdom, 1940-45

Admissions to Hospitals for Injuries. British Troops, Male
Average Annual Rates per 1,000 Strength and Relative Rates

Source: Hollerith Tabulations

1. dverage Annual Rates per | Enemy | Non-Enemy Cause not

1,000 Strength Action Action specified Totals
Head Injuries 0°02 0°64 0-16 0°82
Fractures (Other Sites) 0-08 3°57 riz 4°76
Burns . . . . o-or 0°29 ors 0°45
Old Injuries o-2r 0°43 0°68 1°32
Other Injuries 0:27 3°96 1°67 5°90

Totals 5 3 a a 0-59 8-89 3°78 13°25

Relative Rates

Head Injuries é 3°39 7°20 +2: 6-19
Fractures (Other Sites) - | 13°56 40°16 29-65 35°92
Bums .— Si 3 fs ‘ 1°70 3°26 3°97 3°40
Old Injuries . : : + | 35°59 4°84 17°99 9°96
Other Injuries . : - | 45°76 44°54 44°18 44°53

Totals f : : . | 100 100 100 100

THE ARMY MEDICAL SERVICES 137

Assuming, as before, that all admissions for Injuries were distributed
in the proportions indicated above for E.A. and N.E.A. Injuries and
correspondingly allocating those for which no cause was specified, rates
are as shown in the following table.

United Kingdom, 1940-45

Admissions to Hospitals for Injuries British Troops, Male
Adjusted Average Annual Rates per 1,000 Strength and Relative Rates

Source: Hollerith Tabulations

1. Adjusted Average Annual Rates

per 1,000 Strength Enemy Action | Non-Enemy Action | Totals
Head Injuries . 5 = 0°03 0'79 082
Fractures (Other Sites) _ é o'10 4°66 4°76
Burns. A ; a 0°02 0°43 0°45
Old Injuries 0°43 0°89 1°32
Other Injuries . 0°37 5°53 5°90

Totals . . 3 0°95 12°30 13°25
2. Relative Rates
Head Injuries . a - 3°16 6°42 6+19
Fractures (Other Sites) 3 a 10°53 37°88 35°92
Burns. ‘ ; i 2:11 3°50 3°40
Old Injuries. 2 x 45°26 7°24 9°96
Other Injuries . 2 x . 38°94 44°96 44°53

Totals . 3 . 5 c 100 100 100

Admissions for Injuries caused through enemy action increased
annually from 0-1 per 1,000 in 1941 to 2-6 in 1945. In comparison,
non-enemy action admissions increased from 6 in 1941 to 15 in 1945,
although the peak rate of 18 occurred in 1943. The largest annual
increase in admissions for E.A. injuries occurred in 1944 when the rate
rose from slightly over 0-3 to 1-5 per 1,000. This was accompanied by
a reduction in admissions for N.E.A. injuries. In 1945, however, a
further increase in E.A. injuries was attended by a similar increase in
N.E.A. injuries.

Of the total adjusted average admission rate of over 13 per 1,000 for
injuries, those caused through enemy action accounted for seven per
cent. at slightly under 1 per 1,000. Forty-five per cent. of these admissions
were due to Old Injuries, eleven per cent. to Fractures (other than to
the head), three to Head Injuries and two per cent. to Burns. This trend
is not followed by N.E.A. injuries among which thirty-eight per cent.
were for Fractures, seven per cent. for Old Injuries, six for Head Injuries
and nearly four per cent. for Burns. The relative rates for Old E.A.
injuries are thus six times those for N.E.A., while N.E.A. Fractures are
four times those caused through E.A. Head Injuries are double and

138 CASUALTIES AND MEDICAL STATISTICS

Burns fifty per cent. higher. It is possible that the rate quoted for Old
Injuries caused through enemy action may be somewhat inflated by the
inclusion of those who, having originally been injured in overseas
theatres, particularly in North-West Europe, were re-admitted for
further treatment to hospitals in the United Kingdom.

DEATHS

Statistics relating to deaths in hospitals in the United Kingdom are
recorded in Table 7. Owing to the decision to restrict coding, in which
‘Result on Discharge’ was eliminated, it is possible to present only
statistics relating to the years 1940 to 1943. In this table are shown
deaths as percentages of admissions for diseases (or disease groups) and,
separately, those for injuries. Relative rates within these classifications
are also given. Rates per 1,000 strength for disease and injury are
presented in the table which follows.

United Kingdom, 1940-43
Mortality Rates per 1,000 Strength. British Male Troops
Source: Hollerith Tabulations

CAUSES 1940 1941 1942 1943
Disease . . 0°20 or17 0°20 0°26
Injury . : 0°04 0°03 0:06 0:06

Totals . zi 0°24 0°20 0°26 0°32

Mortality rates were highest in 1943 at 0-32 per 1,000 and lowest in
1941 at 0:20. Deaths through disease ranged from 0-17 in 1941 to 0:26
in 1943, while those from injury varied between 0-03 in 1941 to 0-06 in
1942 and 1943. In 1942 deaths from disease accounted for seventy-eight
per cent. of all deaths while in the remaining years they were between
eighty and eighty-five per cent.

Although the admission rate was low (0-14 to 0-52 per 1,000), deaths
from MENINGOCOCCAL INFECTION recorded the highest rate among
diseases from just under four in 1941 to nearly seven per cent. of
admissions in 1943. The years which witnessed the lower rates of
admission also experienced the heavier percentages of deaths. Per contra,
relative rates were lowest in 1942 and 1943.

Comparatively high mortality rates were also recorded for
TUBERCULOSIS, between two and three per cent. of admissions, with
relative rates at between thirteen and sixteen per cent. of all deaths from
disease.

A diminution in rates occurred in PNEUMONIA. In 1940, nearly two and
a half per cent. of admissions for this disease died. By 1943, this had

THE ARMY MEDICAL SERVICES 139

been reduced to a little over one-half per cent. Diseases of the NERVOUS
SYSTEM were responsible for rates which were remarkably constant at
0-93 per cent. of admissions except in 1941 when the percentage was
0-89.

The largest number of deaths which occurred among diseases was
for Diseases of the DIGESTIVE SYSTEM which recorded from twenty to
twenty-five per cent. of all deaths.

Rates for injuries ranged from 0-7 per cent. of admissions in 1940 to
0-3 in 1945. Those from E.A. injuries were noteworthy for their
percentage diminution, from eleven per cent. of admissions for all
injuries in 1940 to a little over one per cent. in 1943. Deaths from N.E.A.
injuries expressed as percentages of admissions also declined from 0-53
in 1940 to 0-27 in 1943. As relative rates, however, they increased from
49 in 1940 to 81 in 1942 and declined to 57 in the following year.
Relative mortality rates for unspecified injuries ranged from fifteen to
thirty-eight.

BRITISH FEMALE TROOPS

Admission rates of the Women’s Services of the British Army to
Hospitals in the United Kingdom are cited in Tables 8 to 14. Rates per
1,000 strength, Relative Rates, and Comparative Rates are recorded in
Tables 8, g and 1o respectively. The average rates of admission over
the six years under review are presented in Table 11, while admission
rates for females are compared with those for males in Table 12.
Injury rates are exhibited in Tables 13 and 14, and mortality rates for
the years 1940 to 1943 are recorded in Table 15. Admission rates cited
in these tables are subject to the limitations discussed at the beginning
of this section and it is suggested that the correction factors given on
page 110 be used.

Admissions for diseases only varied from 84 per 1,000 strength in 1940
to a peak of 152 in 1943, while those for injuries ranged from 3 in 1940
to g in 1943. Admissions on account of injuries accounted for from three
to six per cent. of all admissions. Relevant rates, to the nearest whole
number, were as follows.

United Kingdom, 1940-45

Rates of Admissions to Hospitals. British Troops, Female
Source: Hollerith Tabulations

Comparative Rates
Rates per 1,000 Strength Relative Rates (1943 = 100)

Years — —
Disease | Injury | Totals | Disease| Injury | Totals | Disease | Injury | Totals
1940 8 3 87 96 4 100 55 38 54
1941 102 3 105 97 3 100 67 7 65
1942 137 145 9s 5 100 or 6 9°
1943 152 9 161 94 100 100 100 100
1944 110 7 117 4 6 100 72 73 73
1945 106 6 112 95 5 100 Jo 6s Jo

140 CASUALTIES AND MEDICAL STATISTICS

The highest annual rates for disease and injury were recorded in 1943
at 152 and 9g per 1,000 respectively, with a peak total admission rate of
161. The lowest rates were registered in 1940 at 84 per 1,000 for disease
and 3 for injury. Injuries accounted for slightly over three per cent.
of all admissions in 1941 to a little more than six per cent. in 1944.
Over the six years were recorded the average rates of 115 for disease and
6 for injury, a total of 121 per 1,000.

DISEASES OF THE EAR, NOSE AND THROAT

Of individual diseases and disease groups, diseases of the EAR, NOSE,
and THROAT were responsible for the highest rate of admission at an
average of slightly under 16 per 1,000, representing nearly fourteen per
cent. of all admissions for disease. These admissions are analysed below.

United Kingdom, 1940-45
Admissions to Hospitals for Diseases of the Ear, Nose and Throat
British Troops, Female
Annual Rates per 1,000 Strength and Relative Raths
Source: Hollerith Tabulations

1. Annual Rates per 1,000 Strength| 1940 1941 1942 1943 1944 1945 | Averages
Otitis Media. =. ss | orga | 0°68 | x18 | aes8 | ree. reg fora
Tonsillitis 2... 193 | 8:54 | r1-10 | 13-23 | 9° 8-7 ost
Other Diseases “92 5714 5°06 s:71 4°56 448 S73
Totals . ‘. :. + | 13°77) | 14°36 | 17°34 | 20°s2 | 15°16 | 14°43 1§°93
Percentages of total admissions
for diseases . . . | 16 14 13 14 14 4 ™
2. Relative Rates
Otitis Media . : : ‘ 6-68 4°74 6-81 7°70 7°52 8-10 6°97
Tonsillitis . . . . | 43°06 | 9°47 | G4:or | 64 rH 62-40 | 60-85 | 59-70
Other Diseases . . - | 0°25 | 35°79 | 29°18 | 27-83 | 30°08 | 31-05 | 33°33
Totals . . «~~. | 100 100 100 100 | 100 100 100

Admissions followed the general trend for all diseases, with annual
increments to 1943, then decreases in the two following years. TONSILLITIS
recorded a peak rate of over 13 per 1,000 in 1943. This represented
nearly nine per cent. of all admissions for disease and sixty per cent. of
group admissions. OTITIS MEDIA was responsible for an average rate of
slightly over 1 per 1,000, some seven per cent. of group admissions.
The relevant average rate for male troops for this group was 12 per 1,000.

DISEASES OF THE GENITO-URINARY SYSTEM

Next in order of numerical importance came admissions for diseases
of the GENITO-uRINaRY System, with rates which rose from 5 per 1,000
in 1940 to over 20 in 1943, declining to slightly under 17 in 1945, with
an average of 14 per 1,000—one eighth of all admissions for disease.

THE ARMY MEDICAL SERVICES 141

Admissions for this group in 1944 and 1945 were greater than those for
diseases of the Ear, Nose and Throat. The increase in admissions from
1940 to 1943 is noteworthy, the rate in 1943 being four times that in
1940. Admissions were lower among male troops at an average of 6 per
1,000.

DISEASES OF THE DIGESTIVE SYSTEM
Following diseases of the Genito-Urinary System in admission rates
came diseases of the DIGESTIVE System. An analysis of admissions for
this group follows.
United Kingdom, 1940-45
Admissions to Hospitals for Diseases of the Digestive System

British Troops, Female
Annual Rates per 1,000 Strength and Relative Rates

Source: Hollerith Tabulations

1. Annual Rates pert,ooo Strength} 1940 1941 1942 1943 1944 1945 | Averages
Gastric Ulcers . e . O10 0-04 0-04 0:06 0-02 o-3r O10
Duodenal Ulcers . A a 0-03 0-02 ons. 0-16 0°20 0-18 or1z
Peptic Ulcers, Unspecified . - _ 0°02 o-or 0°07 _ 0-02
Perforation of Uleers . | | — 0-02 | o-o2 | o-or | o-or = 0-01
Dyspepsia and Gastritis . . 1°48 1°69 1°89 2°00 1°29 117 1°51
Hernia . : . = ~ | O10 O17 0°42 0's9 0°40 0°49 0°3!
Appendicitis . of . Ps 3°29 3°65 7°30 8-99 7°02 7°06 6-22
Haemorrhoids é = . 0°16 0°42 0°56 °°70 9:64: 0°86 0-56
Other Causes . : : +] 3s3 4:05 6-16 6-26 4 3°75 4°64

Totals : . . . 8-69 10°06 16-56 18-78 13°73 13°82 13°62
Percentages of total admissions aa

for diseases . . . | 10 10 12 12 13 13 12

2. Relative Rates
Gastric Ulcers » + +] as | ergo | 9:24 | orga | onts | 2:24 | on7g
Duodenal Ulcers ps 2 0-35 0°20 o-or 0-85 14s 1°30 Oo
Peptic Ulcers, Uns ° — - oz 0°05 o'st _ ors
Perforation of Ule mere a 0-20 | o-12 | o-0g | 0-07 — | 0-07
Dyspepsia and Gastritis . « | 17°03 16:80 11-40 10°65 9°40 8-47 11°67
Hemia. : peed be 1-6 2°54 3°14 2-91 3°55 2°64
Appendicitis . 5 e ~ | 37-8 36-2! 44°08 | 47°87 suag 51°09 | 45°67
Haemorrhoids é A ~ 1°B4 4:18 3°38 a 97 4°61 6-22 4;1L
Other Causes . < + | 40°62 | 40°26 | 37-20 | 33°33 | 29°72 | 27-13 | 34°07

Totals a . a - | 100 100 100 100 100 100 100

Admission rates for this group, commencing at under g per 1,000 in
1940, more than doubled to 19 in 1943 before declining to slightly under
14 in 1945. Relative rates were 10 in 1940 and 1941, 12 in the two years
which followed and, in spite of a fall of 5 per 1,000, rose to 13 in 1944
and 1945.

APPENDICITIS was responsible for nearly one half the admissions for
the group at an average of 6 per 1,000. Annual rates rose from 3 in 1940
to g in 1943 and decreased to 7 in 1944 and 1945. They were nearly
forty per cent. of group admissions in 1940, forty-eight in 1943 and 51 in
1945. As opposed to this, the relative rates of admissions on account of
DYSPEPSIA and GasTRITIs declined annually from 17 in 1940 to 8 in 1945,
while the rates per 1,000 strength increased from 1-5 to 2:0 in 1943,
falling to slightly over 1 in 1945.

142, CASUALTIES AND MEDICAL STATISTICS

Apart from a small decline in 1944, admissions for HAEMORRHOIDS
increased steadily over the years from 0-16 to 0-86 per 1,000. Rates
for HERNIAS varied from 0-1 in 1940 to a peak of 0-6 in 1943 and ULCERS
were responsible for an average rate of 0:25 per 1,000.

It is interesting to compare the female with the male rates of admissions
for this group. These are tabulated below.

United Kingdom, 1940-45
Admissions to Hospitals for Diseases of the Digestive System

Comparison of Male and Female Rates
Source: Hollerith Tabulations

Average Rates per Comparative Rates
1,000 Strength (Male = 100)
Male Male Female
Gastric Ulcer . e 0°32 100 31
Duodenal Ulcer . - 1°38 100 9
Peptic Ulcer : 7 O17 100 12
Perforation of Ulcer 5 or1s, 100 7
Dyspepsia and Gastritis . 3°08 100 52
Hernia E 2 “! 4°95 100 7
Appendicitis ‘ : 2°50 100 249
Haemorrhoids a ‘i 1°79 100 31
Other Causes é : 4°41 100 105
Totals a 3 . 18-75 100 73

The total average rate of admissions of females was some three-
quarters that of male troops. Apart from ‘Other Causes’, for which the
female rate was only slightly more, admissions on account of
APPENDICITIS only were in excess of the male rate. In this instance, it
was two and a half times that for males. The range among females was
nearly 6 per 1,000 and for males only two. The largest increase in
female admissions occurred in 1941 when the rate of 7-3 was exactly
double that in the previous year. Among male troops, the increase was
much smaller, from 1-6 to 2-6 per 1,000. Admissions for DYSPEPSIA and
GASTRITIS were one-half those for males, while for GASTRIC ULCERS and
HAEMORRHOIDS they were approximately one-third.

DISEASES OF THE MUSCULO-SKELETAL SYSTEM
Rates of admission followed the general trend by increasing annually
to 1943 with subsequent declines in the two ensuing years. They are:

Annual Rate per Percentage of total

1,000 Strength admissions for disease
1940 5°40 6
1941 6-14 6
1942 9°38 7
1943 12°64 8
1944 8-73 8
1945 7°92 7

THE ARMY MEDICAL SERVICES 143

The rate in 1943 was more than double that in 1940 and was half as
much again as that in 1945. The average rate of slightly under 8-5 per
1,000 was some seven per cent. of all admissions for disease.

SCABIES

Admissions for scabies were notable for the remarkable increase in
1941 and for the equally dramatic decline in 1943. Rates, which are
enumerated below, increased from 2 in 1940 to 14 in 1941 and fell from
13 to 4 in 1943:

Annual Rate per Percentage of total
1,000 Strength admissions for disease

1940 2°44 3

1941 14°08 14

1942 13°03 10

1943 3°97 3

1944 O51 0-5

1945 0°25 0-2

The average rate over the six years was under 6 per 1,000, while that
for the period other than 1941 and 1942 was one-quarter at 1-4. The
rates experienced by male troops averaged less at 5 per 1,000; they were
lower in 1941 and 1942 at 11 and 8 per 1,000, but in 1940 were four
times the female rate, at 9 per 1,000.

DISEASES OF THE SKIN

Admissions which on the average were only very slightly lower than
for Scabies, followed the general trend for all diseases, with the peak
rate in 1943, and were as follows:

Annual Rate per Percentage of total
1,000 Strength admissions for disease
1940 3°36 4
1941 5°02 5
1942 7°94 6
1943 8-04 5
1944 5°74 5
1945 3°87 4

These admissions averaged at 5-66 per 1,000, equivalent to five per
cent. of all admissions for disease and were sixth in order of numerical
importance. Male rates, which averaged over 12 per 1,000 were second
in order of precedence and represented ten per cent. of all disease
admissions.

DISEASES OF THE RESPIRATORY SYSTEM

This group was responsible for admissions which ranged from 4:3 to
6-5 per 1,000. Rates are analysed in the table which follows.

144 CASUALTIES AND MEDICAL STATISTICS

United Kingdom, 1940-45
Admissions to Hospitals for Diseases of the Respiratory System. British Troops, Female.
Annual Rates per 1,000 Strength and Relative Rates
Source: Hollerith Tabulations

1. Annual Rates per 1,000 Strength} 1940 1941 1942 1943 1944 1945 | Averages
Bronchitis. i : + | 3°72 3°75 3°46 41s 2°50 3:01 3°43
Pleurisy Dot DD] 023 | onrs | 0-48 | 0-45 0-32 | o-r2 | 0-29
Other Causes | 4 Dold a2s | 0-84 1°39 1°87 1°48 1°23 1°34
Totals 3 5 : - | 5720 4°74 5°33 6°47 4°30 4°36 5°07

Percentages of total admissions
for diseases. « i 6 5 4 4 4 4 -

a. Relative Rates

Bronchitis =. 5 : - | 70°54 | 79°11 | 64-92 64°14 58-14 | 69°04 | 67°79

Pleuris: . . . + | 4742 3°16 9:00 “of 7°44 2-78 3:7.

Other Causes . a ‘ ~ | 24°04 17°72 26°08 28-90 34°42 28-21 28-48
Totals . : . « | 100 100 100 100 100 100 100

BRONCHITIS at the average rate of 3-4 per 1,000 was some 0°5 less
than the rate for males, although the relative rates were almost identical.
Admissions for PLEURISY were at a little more than half the male rate.

MENTAL DISEASES
This group caused admissions at rates which averaged 4-4 per 1,000
over the six years. They increased from 1-8 in 1940 to 6-6 in 1943 and
declined to 5-5 by 1945. Rates are shown in the following tables.
United Kingdom, 1940-45
Admissions to Hospitals for Mental Diseases. British Troops, Female.

Annual Rates per 1,000 Strength and Relative Rates
Source: Hollerith Tabulations

1. Annual Rates per1,000 Strength| 1940 1941 1942 1943 1944 1945 | Averages

Psychoses . . . . 0°49 0"40 rig 1°34 084 0°92 0-86
Psychoneuroses . _ . 0-92 2-1 3°42 4°60 3°41 4°42 31s
Other Causes . . . . 0°40 ong 0-56 0-61 o-18 o18 0°40
Totals a . S . 1-81 g:or S:17 6'ss 4°43 5°52 4°42
Percent: of total admissions
for diseases. . . 2 3 4 4 4 5 4

Psychoses + i . » | 27°07 13°29 | 23°02 | 20°46 18-96 16-67 19°50
Psychoneuroses = » | §0°83 714: 66-15 70°23 76-98 80-07 71°43
Other Causes . . s . | 22°10 15-2! 10°83 9°31 4°06 3°26 9°07

Totals . . . . 100 100 100 100 100 100 100

Nearly three-quarters of the admissions for this group were on account
of PSYCHONEUROSES, rates for which increased from 0-9 to 2:2 in 1941,
to a peak of 4-6 in 1943. They declined to 4-4 in 1945. The average rate
of 3 per 1,000 was two-thirds that for males. Admissions due to
PSYCHOSES were slightly higher among women at 0-86 compared with
0°76. Group admissions were four per cent. of all admissions for
diseases—in the case of males, it was five per cent.

THE ARMY MEDICAL SERVICES 145

RUBELLA

Admissions for this infectious disease were distinguished by the
remarkably high rate, in 1940, of nearly 13 per 1,000, compared with the
average of 1-5 for the following five years. It has already been observed
that among male troops in the United Kingdom, there occurred a
comparatively high rate of over 4 per 1,000 in 1940, as against the
subsequent quinquennial average of 0-68. Rates for the sexes are
presented in the table which follows.

United Kingdom, 1940-45
Admissions to Hospitals for Rubella
Comparison of Male and Female Rates per 1,000 Strength
Source: Hollerith Tabulations

Year Males Females
1940 4°34 12°78
1941 0°43 0°44
1942 0°23 0:69
1943 0-61 1°43
1944 114 3°92
1945 1°00 reay.

Average

1940-45 1°29 3°41

Average

1941-45 0°68 1°53

Normally, it would seem that admissions of females for Rubella are
approximately twice those for males, but in 1940, when rates were much
higher than the average, they were three times the male rate.

COMMON COLD AND INFLUENZA

Peak admissions for COMMON COLD occurred in 1941 and 1943, while
those for INFLUENZA were in 1940 and 1943. It was previously noted
among male troops that high admission rates for Common Cold and
Influenza also occurred in 1943. The following table shows the relevant
rates.

United Kingdom, 1940-45
Admissions to Hospitals for Common Cold and Influenza
British Troops, Male and Female

Annual Rates per 1,000 Strength
Source: Hollerith Tabulation

Common Cold Influenza
Males Females Males Females
1940 2°61 2°50 3°47 4°12
1941 2:77 4°18 1°48 1-12
1942 2°02 2-71 1-06 1°13
1943 4:12 4°55 3°42 4°05
1944 1°36 1°48 1°07 085
1945 1°82 1°60 0°85 0°49

Average Rates 2°45 2°84 1°89 1°95

146 CASUALTIES AND MEDICAL STATISTICS

There was but little difference in the average rates of admission
between the sexes for Influenza. In the case of Common Cold, the
difference was 0-4 per 1,000, being higher among women and in only
two of the six years were admission rates lower than for men, and then
but little. Subject to standardisation, it would appear that the females
were slightly more prone to Common Cold.

DISEASES OF THE CARDIO-VASCULAR SYSTEM

Admissions for this group of diseases averaged 2-2 per 1,000 as
opposed to nearly twice that rate for males. They followed the trend
exhibited by males by increasing annually to 1943, declining in 1944 and
rising in the final year to a rate less than that recorded in the peak year
of 1943. Rates are analysed hereunder.

United Kingdom, 1940-45
Admissions to Hospitals for Diseases of the Cardio-Vascular System
British Troops, Female
Annual Rates per 1,000 Strength

Source: Hollcrith Tabulations

1940 1941 1944 1945 | Averages
Valvular Disease of the Heart. | 0-10 | 0-10 0-07 = 0-09
Varicose Veins... | 043 | 0-65 1-68 1ezr 147
Other Causes. 5 ss | 0°76 | 0-74 0-42 | o-49 | 0-69
Totals . . : . 129 1°49 217 2°70 2°20
Percentages of total admissions
20 23 19

for diseases. . sy is ms | 18 20

VARICCSE VEINS accounted for more than one-half of all group admis-
sions (among males they were nearly three-quarters) at an average rate
of 1-4 per 1,000 which was exactly one-half the male rate. Admissions for
VALVULAR DISEASE of the HEART were comparatively low at 0-09 per 1,000
compared with the male rate of 0-24.

OTHER DISEASES

PNEUMONIA accounted for admission rates at 1°35 per 1,000 which
were nearly 1 per 1,000 less than for males. Those for TUBERCULOSIS at
1°12 were also slightly lower. Of the latter, sixty per cent. of the cases
were the Pulmonary type, compared with eighty per cent. in males.
Cases of MENINGOCOCCAL INFECTION, which recorded average rates at
two-thirds those of males, provided the only instance among diseases
where admission rates decreased annually. There were no recorded
admissions in 1945. For MUMPS and DIPHTHERIA rates of admission
among females were greater than those of the opposite sex by over
seventy per cent. in each case. The average rates for women were 1-01
and 0-78 respectively.
INJURIES

Admission rates to hospitals of females on account of injuries were
approximately one-half those for males. They increased from 3 in 1940
to 9 per 1,000 in the peak year of 1943 and closed at 6 in 1945. On the

THE ARMY MEDICAL SERVICES 147

average, they were some five per cent. of all admissions (males were
ten per cent.).

As was the case with male troops, injuries were classified in the
Hollerith tabulations according to whether the injuries were, or were
not, the result of enemy action or the cause was not so specified.
Rates per 1,000 strength are given in Table 13.

Those known to be caused by enemy action were only slightly less
than for males in 1940 and 1941 but in the succeeding years the difference
in rates was more marked for, while this type of injury among males
rose from O-I per 1,000 in 1940 to 1-9 in 1945, the female rates declined
from 0-07 in 1940 to 0-03 in 1943, rose to 0-12 in 1944, followed by no
admissions in 1945.

Injuries not due to enemy action recorded rates which increased from
2 per 1,000 in 1940 to 6 in 1943, finally declining to 4 in 1945, with an
average of 4 per 1,000 compared with g in the case of males.

In Table 14 are consolidated the rates of admission presented in the
previous table and classified according to Head Injuries, Fractures
(other than to head), Burns, Old Injuries, and Other Injuries.

Head injuries, with an average rate of 0-6 per 1,000, accounted for
ten per cent. of all injuries and were more frequent in 1943 and 1944 when
the rates exceeded 0-8 per 1,000. Fractures, other than those to the
head, were responsible for more than a quarter of all injuries and
recorded a comparatively high rate of 2-66 in 1943 against an average
of 1-65. Rates for Burns were heaviest in 1944 and for Old Injuries in
1943. Burns accounted for ten per cent. and Old Injuries some six per
cent. of all injuries.

DEATHS

As.with mortality statistics for males, and for the same reason, it is
possible to present rates for the years 1940 to 1943 only. These are
recorded in Table 15 as percentages of admissions by diseases or disease
groups. Relative rates are also included.

Because there were so few deaths, particularly in 1940 and 1941, and
in view of the great disparity in the numerical strengths of the sexes in
the Army, comparisons of mortality rates between males and females
would serve no useful purpose.

The greater number of deaths occurred in 1943; indeed, more deaths
are recorded for that year than during the triennium immediately
preceding.

During each of the years 1941, 1942, and 1943, TUBERCULOSIS was
responsible for one quarter of the deaths from disease, more than any
other disease or group. In 1943, PNEUMONIA caused one-seventh of the
deaths, and Diseases of the GENITO-URINARY System, one-ninth. It is
perhaps worth recording that there were no deaths from Pneumonia
Prior to 1943.

6cms

1448 CASUALTIES AND MEDICAL STATISTICS

‘TABLE
United Kingdom, ;. Admissions to Hospitals. British Troops, Male
ge sa a Rates per 1,000 Spreath

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SL HOH00 AR000 MOnOR HONK ROKAe BOOKA BOOnH

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System

‘Teeth and Gums

of the Mouth,
Digestive System

of the Genito-Urii System
of the Musculo-Skeletal
Diseases of the Areolar Tissue

ic Croup of Fevers

Diseases of the Cardio-Vascular System

Diseases of the Eye
Diseases
Diseases of the
Disord

Diseases

Diseases

Diseases of the Nervous System .
Diseases of the Ear, Nose and Throat ;

Other Infestations
Mental Conditions

Scabies

Diseases
Diseases
Diseases

P.U.O.

Diphtheria
Dysent
Influenza
undic
jalaria
Measles
Venereal Diseases. 2
Other Diseases due to Infection

Enteri

149

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United Kingdom, 1940-45. Admissions to Hospitals. British Troops, Male

Relative Rates

CASUALTIES AND MEDICAL STATISTICS

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Diseases of the Cardio-Vascular System

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154 CASUALTIES AND MEDICAL STATISTICS

TABLE 4
United Kingdom, 1940-45
Admissions to Hospitals for Diseases. British Troops, Male
Average Rates per 1,000 Strength in Order of Precedence, with Relative Rates

Source: Hollerith Tabulations

CAUSES Rates
Diseases of the Digestive System . ‘ : 18-75
Diseases of the Skin 7 z 12°37
Diseases of the Ear, Nose and Throat . > 11°85
Diseases of the Musculo-Skeletal Systern i 11°00
Venereal Diseases i : E ¢ 10°83
Diseases of the Genito-Urinary Tract . A 6°47
Mental Conditions : é . 6°18
Diseases of the Respiratory System : ‘ 5°68
Scabies 5 2 4 5°22
Diseases of the Areolar Tissue * + a 4°13
Diseases of the Cardio: Vaseulas System a -y 4°01
Malaria < s ri . F 2°93
Common Cold A A 2°45
Diseases of the Nervous s System 2°38
Pneumonia = é . 2°24

Diseases of the Mouth, Teeth and Gums
Influenza. . .
Diseases of the Eye és 4 a
Jaundice, Catarrhal “ : .
Rubella. 5 : . .

Tuberculosis
Diseases of the Blood and Blood- forming Organs
Wiesel 5: =

Scarica’ Fever: : 4 :

Diphtheria .
Measles. 3
Disorders of Nutrition and Metabolism 4

Meningococcal Infection F ‘ i
Rheumatic Fever . . . .

Peereren
Nd st oon
CORSE

Diseases of the Breast .
P.U.O. 4 . 5
Diseases of the Endocrine System : “i
Poisoning i:

Enteric Group of Fevers

All Other Diseases . . . e
Totals. - é . ‘ f

Note: For suggested correction factors see page 110.

THE ARMY MEDICAL SERVICES 155
TABLE 5
United Kingdom, 1940-45
Admissions to Hospitals for Injuries. British Troops, Male
Rates per 1,000 Strength

Source: Hollerith Tabulations
1. Enemy Action 1940 1941 1942 1943 1944 1945
Head Injuries. 0-02 0-01 o-or 0-02 0°05 0°03
Fractures (Other Sites). o-or o-or o-'or 0°05 or18 o-2r
Burns . 0°00 0-00 0°00 0°00 o-or O-o1
Old Injuries 2 0°02 0°02 0°02 0°03 0°23 098
Other Injuries. * 0:06 0°04 0:08 O-14 0°62 0:66

Totals o'10 0-08 or1z 0°24 1°09 1°90
2. Non-Enemy Action
Head Injuries. 0°25 0°26 0°67 0-85 0:78 1°04
Fractures (Other Sites). rig 1°78 4°34 5°13 4°92 4°04
Bums 0-10 o-13 0°30 0°42 O°41 0°43
Old Injuries S 2 0°33 0°35 0°56 0°54 0°37 0°42
Other Injuries 1°56 1°g1 cir 6-18 3°77 5°24

Totals 3°42 4°42 10°97 13°12 10°24 11°16
3. Cause Not Known
Head Injuries. o'10 0°08 org 0°24 o-17 0°16
Fractures (Other Sites). 0°44 0°44 1°46 1°65 1°31 I°4t
Burns 0:06 0-07 o's 0°23 0°24 O17
Old Injuries O57 0°65 0-62 060 o'6r 1-06
Other Injuries 0:76 o-7I 2-or 2:71 1°95 1°86

Totals 1°92 1°94 4°43 5°42 4°29 4°66
Total admissions through

injury 5°44 6°44 15°52 18-78 15°62 17°71
Percentage of aamissions

for all causes 5 6 10 Ir 1 10

Note: For suggested correction factors see page 110.

6°cms

156 CASUALTIES AND MEDICAL STATISTICS

TABLE 6

United Kingdom, 1940-45
Admissions to Hospitals for Injuries. British Troops, Male
Relative Rates

Source: Hollerith Tabulations

1. Enemy Action

Head Injuries. fs
Fractures (Other Sites) .
Old Injuries

Other Injuries

Totals

2. Non-Enemy Action

Head Injuries. - 7 8 7
Fractures (Other Sites) . 39 48 40
Burns. . : 3 4 3
Old Injuries 4 3 5
Other Injuries 47 37 45
Totals 100 100 100
3. Cause Not Known
Head Injuries. e 5 4 3
Fractures (Other Sites) . jo 31 jo
Burns. . : 4 6 4
Old Injuries Ww 4 23
Other Injuries 50 45 40
Totals 100 100 100

157

THE ARMY MEDICAL SERVICES

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164 CASUALTIES AND MEDICAL STATISTICS

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THE ARMY MEDICAL SERVICES

TABLE 11

United Kingdom, 1940-45
Admissions to Hospitals for Diseases. British Troops, Female
Average Rates per 1,000 Strength, in Order of Precedence, with Relative Rates

Source: Hollerith Tabulations

CAUSES

Average | Order of
Rates | P:

recedence

Diseases of the Ear, Nose and Throat
Diseases of the Genito-Urinary System .
Diseases of the Digestive System .
Diseases of the Muscle. Sheil System
Scabies .

Diseases of the Skin .

Diseases of the Respiratory System

Mental Conditions

Rubella. : :
Diseases of the Areolar ‘Tissue : c <

Common Cold.

Diseases of the Mouth, “Teeth and Gums
Diseases of the Cardio-Vascular Sysrem c
Influenza. :
Diseases of the Nervous System

Venereal Diseases

Diseases of the Blood and Blood- forming Organs
Pneumonia '

Measles }

Scarlet Fever

Tuberculosis
Mumps

Diseases of the Eye
Diphtheria . i

Dysentery .

Jaundice, Catarrhal ‘

of the Endocrine System
Diseases of the Breast . : :
P.U.O. :
Disorders of Nutrition and Metabolism :

Rheumatic Fever 4 é .
Meningococcal Infection . . .

Poisoning . : : .
Malaria
Enteric Group of Fevers 7 e : s

All Other Diseases . - : 5
Total Admissions for Diseases. .

“

°

115°

HR DND WHOAUN WOO

noe

Ooonn

eo0000

© 000

OO MID Uswnn

165

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0°64

e000
»
"

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a

s

100°00

Note: For suggested correction factors see page 110.

166 CASUALTIES AND MEDICAL STATISTICS

TABLE 12

United Kingdom, 1940-45
Admissions to Hospitals for Diseases (over 1 per 1,000)
British Troops, Female. Comparative Rates (Male= 100).
Based on average admission rates

Source: Hollerith Tabulations

DISEASES Males | Females

1 Measles : . . : . . : 100 269 1

2 Rubella iz “ i - ‘e 3 . 100 264 2

3 Scarlet Fever 3 2 : 100 226 3

4 Diseases of the Genito-Urinary System e 100 223 4

5 Diseases of the Blood and Blood-forming Organs 100 175 5

6 Mumps 2 ¢ 100 174 6

7 Diseases of the Ear, Nose and ‘Throat 7 g 100 134

8 Diseases of the Mouth, Teeth and Gums. é 100 120 8

9 Common Cold. ‘ 3 : 100 116 9
10 Scabies 3 rs : é 2 ; 2 100 109 10
W Influenza. : 2 3 100 103 11
12 Diseases of the Respiratory System 3 is e 100 89 12
13 Tuberculosis . . 100 87 13
4 Diseases of the Musculo-Skeletal System f 4 100 76 4
15 Diseases of the Nervous System. . : 100 75 15
16 Diseases of the Areolar Tissue " B 4 100 74 16
17 Diseases of the Digestive System * . % 100 75 17
18 Mental Conditions ‘ 3 2 A 100 vas 18
19 Pneumonia . Pi z 100 60 19
20 Diseases of the Cardio-Vascular System % , 100 55 20
ar Diseases of the Skin “ 2 ze S “ 100 46 21
22 Venereal Diseases . a . 5 e 5 100 15 22
23 Total Admissions for Diseases . $ é 100 go 23

TABLE 13

United Kingdom, 1940-45
Admissions to Hospitals for Injuries. British Troops, Female
Rates per 1,000 Strength

Source: Hollerith Tabulations

1. Enemy Action | 1940

Head Injuries - 0°04 o-or _ o-'or -
Fractures (Other Sites) « _ _ o-or o-o1 o'or -
Burns . = = = at _ cm
Old Injuries ‘ . _ 0°02 o'or ae o-'or =
Other Injuries. a 0:07 _ o-o1 0°03 0:09 =.

Totals . . é 0°07 | 0:06 | 0-04 0°03 o-12 _

THE ARMY MEDICAL SERVICES 167

2. Non-Enemy Action

Head Injuries. 0°26 0°40 O°55 0°61 0°69 0°49
Fractures (Other Sites) « 0°59 0°49 1°49 1°90 1°43 1°35
Burns 0°23 0°30 0°46 0°49 0°61 0°55
Old Injuries ‘ «| 016 0°06 017 0°25 0°20 018
Other Injuries 0-92 1-08 2°53 2°67 2°06 1-66

Totals. $ «| 2017 2°34 5°21 5°92 4°99 4°23
3. Cause Not Known
Head Injuries 0°03 _- or1s 0-19 Orrs or12
Fractures (Other Sites) 0°26 O17 0°64 0-76 0°39 0°37
Burns - 0°23 Orr o-21 0°28 0°27 0-18
Old Injuries o°13 0°08 0°24 0°29 0°22 or12
Other Injuries 0°53 0°65 1°31 1°63 0°95 086

Totals. F : 119 I-or 2°56 3°14 1°98 1°66
Total Admissions hroushy

Injuries . ; 3°43 3°40 7°81 9:08 7:99 5°89
Percentages of Admissions

for All Causes . . 4 3 5 6 6 5
Note: For suggested correction factors see page 110.

TABLE 14
United Kingdom, 1940-45
Admissions to Hospitals for Injuries. British Troops, Female
Annual Rates per 1,000 Strength and Relative Rates

Source: Hollerith Tabulations
1. Annual Rates per 1,000

Strength 1940 1941 1942 1943 1944 1945
Head Injuries. 0°29 oO: o-7r 0-80 0°85 0:61
Fractures (Other Sites). 0°85 0-66 215 2°66 1°83 1°72
Burns a 0°46 O'4I 0°67 0°76 0:88 0°73
Old Injuries 0°29 0°16 0°43 0°54 0°43 0°30
Other Injuries 1°53 1°73 3°85 4°32 3°10 2°52

Totals . a 4 3°43 3°40 7°81 9°08 7°09 5°89

2. Relative Rates

Head Injuries. 8-48 12°94 9:09 8-81 11°99 10°37
Fractures (Other Sites) | 24°85 19°41 27°53 29°40 | 25°81 29°25
Burns = - | 13°45 12°06 8-58 8-37 12°41 12°41
Old Injuries : a 8-48 4°71 5°51 5°95 6-06 5°10
Other Injuries. + | 44°74 | 50°88 | 49°30 | 47°57 | 43°72 | 42°86
Totals. 2 + | 100 100 100 | 100 100 100

Note: For suggested correction factors see page 110.

168 CASUALTIES AND MEDICAL STATISTICS

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CHAPTERII
FRANCE, 1939-40

N SEPTEMBER 3, 1939, His Majesty’s Government declared war
O: Germany. Nine days later the first contingent of the British

Expeditionary Force landed in France. Germany invaded
Holland, Belgium and Luxemburg on May 10, 1940 and less than four
weeks later the British Expeditionary Force was being evacuated, mainly
through Dunkirk.

Statistics which follow are the most accurate available of admissions
to hospitals in France, of personnel of the B.E.F., for the seven months
October 1939 to April 1940. The normal routine monthly returns
(A.F. A.31) from Military Hospitals setting forth crude numbers of
admissions by diseases, together with particulars of deaths, etc., are not
available. There are, however, two other sources from which much of
this information is obtainable.

The first is a record of admissions maintained at the Medical
Directorate of Headquarters, B.E.F. In it are given precise details of
admissions to hospitals for some seventeen diseases and disease groups.
From the particular detail with which the record is permeated and
because of the nature of these specific diseases, it is not unreasonable to
infer that the data recorded were extracted from Hygiene Reports
submitted to the Director of Hygiene.

This record is deficient (at least, in so far as present purposes are
concerned) in that data relating to many diseases do not appear, figures
relating to injuries are not included, and there is but little information
in it regarding deaths. There is, however, much valuable information
contained therein relating to admissions on account of the seventeen
diseases before mentioned, particularly where, in the case of certain
diseases, full particulars (i.e. number, rank, name, unit, and date of
admission) of patients are quoted. This is of especial value as it enables
a form of control to be exercised on the other available source of
statistics.

This is, of course, the tabulations produced by the Hollerith section
of the War Office from cards punched with data obtained from Hospital
Record Cards (A.Fs. I.1220). It is a truism that the accuracy of the
information, both as regards quantity and quality, contained in the
tabulations is dependent entirely upon the accuracy of the information
fed into the tabulating machine. That is to say, if the punched cards are
deficient in quantity and if the information contained in the remainder
is erroneous, then the final product will certainly be not more precise.

The limitations of the production of Army Medical Statistics via
punched card machinery during the war have already been discussed

170

THE ARMY MEDICAL SERVICES 171

and efforts made to evaluate the accuracy of tabulations produced for
certain commands. As stated before, one cause of inaccuracy, and which
was probably by far the largest factor, was the loss of primary records
due, mainly, to enemy action. That many cards were so lost during the
campaign in France cannot be doubted. Indeed, the loss was undeniably
considerable when the Germans overran that country. An examination
of admissions to hospitals recorded in both sources of information
reveals serious discrepancies over the whole period under review.
Expressed as a percentage of those quoted in B.E.F. records, admissions
recorded in the Hollerith tabulations were

1939 1940
October 58 percent. January 56 per cent.
November 54 per cent. February 54 per cent.
December 58 per cent. March 56 per cent.
April 54 per cent.

That for the seven months ended April 1940 was fifty-five per cent.
From this, and assuming the B.E.F. figures are correct, it would
appear that
(a) Of the A.Fs. I.1220 received in the War Office, only fifty-five per
cent. were coded.
or

(b) Forty-five per cent. of A.Fs. I.1220 were not received in the War
Office for coding.

As far as (a) is concerned, the ‘Guide to Procedure’ for the Medical
File (of punched cards) issued by the Hollerith Section of the War Office
categorically states that ‘there was no percentage coding prior to
September 1944’. It can only be assumed, then, that

(a) a very considerable leakage of A.Fs. I.1220 occurred,

(b) A.Fs. I.1220 received in the War Office were (unofficially) not all
coded,

(c) the discrepancy was a combination of both these factors
or
(d) the B.E.F. record is faulty.

To some degree, an evaluation of the accuracy of the Hollerith
tabulations can be made. That this is possible is due to the fortunate
inclusion in the B.E.F. record of personal particulars of patients
admitted for two causes. There is no question of the inaccuracy of these
rolls and, if diagnoses are faulty, it can, by virtue of the peculiarity of the
circumstances under which patients for at least one of the two causes
were admitted, affect the issue but little. Details are:

172 CASUALTIES AND MEDICAL STATISTICS

Cause 1 | Cause 2

(a) Admission as enumerated in Hollerith Tabulations . 142 30

(b) Admissions as enumerated in B.E.F. records .

(c)

41

(a) expressed as a percentage of (b)

Admissions due to these two causes admittedly are a small sample of
the total for all causes. It is possible, as hinted above, that some final
diagnoses differed from those recorded in the B.E.F. record but, if this
were so, it would be to a limited extent only and the percentage deficiency
of approximately thirty would tend to gravitate towards the overall
deficiency of forty-five per cent.

On balance it does appear that the B.E.F. records are more accurate
than the punched card tabulations. In view of this, statistics of admissions
to hospitals which follow are those computed from the former. Monthly
admission rates per 1,000 strength are presented in Table 17, and these
are followed by relative and comparative rates in Tables 18 and 19
respectively. For the record, relative rates of admissions based on the
Hollerith tabulations are included as Table 20.

Other statistics presented in this section are medical transfers from
France to England. Such transfers did not necessarily imply invaliding
from the Army. They may have been made for a variety of reasons,
including the necessity of obtaining more specialised treatment than was
available in military hospitals in France, and compassionate grounds.
Such statistics are given in Tables 21 and 22. Figures were obtained
from War Office records which were based on nominal rolls received at
ports of disembarkation.

ADMISSIONS

Admissions to hospitals ranged from 42 per 1,000 in October to a
peak rate of 61 in January, following which they declined to 37 in April.
They were equivalent to an annual rate of 568 per 1,000. The high rate
in January, which was almost entirely due to increased admissions on
account of Influenza and ‘other diseases of the Respiratory System’, was
half as much again as the rate recorded in October. The lowest rate,
occurring in April, was nine-tenths that for October and three-fifths the
peak rate in January.

Of the diseases and disease groups recorded in the tabulations, the
highest admission rate was due to other diseases of the RESPIRATORY
system. In four months there was a dramatic increase in admissions, the
rate in January being seventeen times that in October when 0-7 per
1,000 was registered. In November the rate was 2-9, in the following

THE ARMY MEDICAL SERVICES 173

month it doubled to 6-o while in January it increased to the peak rate of
12-2. A decline to 5-3 per 1,000 followed in February and by April the
rate had fallen to 2-1. The average rate was 4-5 per 1,000, being equiva-
lent to ten per cent. of all admissions.

Next in numerical order of importance came scaBiEs which claimed an
average rate of 3-3 per 1,000, some seven per cent. of all admissions.
Except in December, when they abated to 2-4, admissions increased
each month from 2-6 per 1,000 in October to 4-5 in April, an increase of
seventy-five per cent.

Admission rates on account of VENEREAL DISEASES were extremely
steady, having a range of only 0-3, i.e. from 2-23 per 1,000 in both
January and April to 2-53 in December. This group accounted for five
per cent. of all admissions. INFLUENZA was responsible for a rise in the
admission rate of 1-5 in December to slightly under 8 per 1,000 in the
following month. In February, admissions had subsided to 1-7 and by
April they were at under 0-5. The rate for TONSILLITIS in October
(0-9 per 1,000) was doubled by January but subsequent admissions
declined until April, when the rate was just over 1 per 1,000.

The rates for PULMONARY TUBERCULOSIS exhibited no particular trend,
but were rather erratic over the months, ranging from 0-06 in January
and April to 0-12 in February. Admissions for RUBELLA were compara-
tively high in February and March at 4 and 3 respectively before
declining to 0-5 in April. The average rate for RHEUMATIC FEVER for the
five months December to April was under 0-04 per 1,000. In November
there were no recorded admissions, but in October, the first month
after the initial landing of the force, the rate was surprisingly high at
0°25 per 1,000.

CEREBRO-SPINAL FEVER provided rates which, although never more than
0*5 per 1,000, were considerably higher during the last four months than
in the first three. In the latter, the average monthly rate was less than
©-02 per 1,000, but in the succeeding four months it rose to 0-30 with a
peak of slightly under 0-5 in March. Admissions on account of IMPETIGO,
which accounted for two per cent. of all admissions in October and
April, were highest in October and November at over 0-8 per 1,000.
They declined to 0-5 by February but climbed to 0-7 by April.

Rates for DIARRHOEA, after declining from 0-32 in October to 0-15 in
November, thereafter remained fairly constant. Figures are not available
for MEASLEs until February 1940, when the rate was 0-33 per 1,000. In
each of the two months which followed the comparatively low rate of
0-04 was recorded.

MEDICAL EVACUATIONS TO THE UNITED KINGDOM

Tables 21 and 22 record evacuations to the United Kingdom on
medical grounds. It has already been mentioned that these movements

174 CASUALTIES AND MEDICAL STATISTICS

of the sick did not necessarily imply discharge from the Army for
medical reasons. This was particularly so in May and June when,
consequent on the rapid advance of the German Army, evacuations
were exceptionally numerous and many patients who, in the preceding
months, would have recuperated in France, were sent home.

During the last quarter of 1939 evacuations did not reach 1,000 in
any one month, while the monthly average was under 800. From
January 1940, transfers to the United Kingdom increased each month
(except in March when they were 200 less than in February). Evacuations
in April were over twice those in January and nearly five times the
number recorded for October. That the increasing tempo of evacuations
exceeded that of the build-up of the force is seen in the following
comparative table where, in October, both the size of the force and the
number of evacuations are represented by 100.

Size of Force Number of Evacuations
1939 October 100 100
November 121 133
December 129 89
1940 January 142 183
February 177 240
March 191 209
April 222 469

Note: No reliable strength figures are available for May and June

Up to, and including April 1940, evacuations due to disease
accounted for between eighty and ninety per cent. of all evacuations.
In May and June they dropped to between thirty and forty per cent.
Throughout the nine months, slightly over one half of the cases
evacuated were because of disease. The average composition of these
evacuations was:

20 per cent. and over Diseases of the Digestive System

15 to 19 per cent. NIL

10 to 14 per cent. Diseases of the Bones, Joints, etc.

Diseases of the Skin

5 to 9g per cent. Diseases of the Nervous System
Diseases of the Respiratory System
Mental Disorders

1to 4 per cent. Diseases of the Urinary System
Diseases of the Ear
Diseases of the Eye
Venereal Disease
Tuberculosis

THE ARMY MEDICAL SERVICES 175

Pneumonia
Diseases of the Generative System
Meningococcal Infection

Under 1 per cent. All others

Nearly fifty per cent. of evacuations were on account of injury.
No cases of injury due to Enemy Action were evacuated before February.
In May the number was over seven thousand, but in the next month
they had declined by nearly one half. Evacuations for N.E.A. injuries,
which totalled less than one half those caused by enemy action, increased
from just over 100 in October to 500 in April, 1,750 in May, and 1,450
in June.

176 CASUALTIES AND MEDICAL STATISTICS

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177

THE ARMY MEDICAL SERVICES

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178 CASUALTIES AND MEDICAL STATISTICS

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TABLE 20
B.E.F. France, 1939-40
Causes of Admissions to Hospitals British Troops

THE ARMY MEDICAL SERVICES

Relative Rates

Total V.D.

Venereal Disease—Sckt eas
Venereal Disease—Other Types and
Other Infectious Diseases —

Scabies . %
Other Infestations

‘Source: Hollerith Tabulations

179

18 CASUALTIES AND MEDICAL STATISTICS

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181

THE ARMY MEDICAL SERVICES

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182 CASUALTIES AND MEDICAL STATISTICS

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183

THE ARMY MEDICAL SERVICES

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184 CASUALTIES AND MEDICAL STATISTICS

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panuyyuoy—ez T1EV,L,

CHAPTER III

North-West Europe
1944 and 1945

ATA REGARDING British patients treated in medical units in North-

West Europe have been assembled from various sources. In

preparing the tabulations which follow, difficulty was experienced
initially, due to there being no regular statistical returns in existence,
either in the War Office or at Headquarters in Germany. These records
did not appear to have been available when the ‘Statistical Report on
the Health of the Army, 1943-45’ was written, for in that Report only
statistics relating to wounds and injuries in Normandy during June and
July, 1944, and the rates of Venereal Diseases from February 1945 to
February 1946, are recorded.

Recourse was, therefore, made to other, albeit less satisfactory,
sources. Tabulations were produced by the Hollerith section of the
War Office. These gave information of certain cases admitted to hos-
pital. As related elsewhere the man-power situation obtaining during
the war, and for some time subsequently, precluded the coding of all
Army Forms I.1220 received in the War Office, and, in so far as North-
West Europe was concerned, a ten per cent. sample was taken, com-
mencing with admissions which occurred on or after September 1,
1944. A hundred per cent. coding of admissions occurring before that
date was made. The sample was taken by extracting all A.Fs. 1.1220,
the army number of which ended with the digit 5. These were coded
and cards punched.

Other sources from which statistics were obtained were some monthly
Hygiene Reports, Army Forms A.35 (Report of Notifiable Diseases) and
V.D. returns, all hereinafter designated Hygiene Reports.

It is known that the cards stored by the Hollerith section of the War
Office for the war years are deficient, due to losses of A.Fs. I.1220 in
transit, a non-rendition of forms, leakages from E.M.S. hospitals, etc.,
of which mention has already been made. Indeed, an assessment was
made in 1945, when nominal rolls of wounded evacuated from Nor-
mandy in June and July were used as a control. It was discovered, in
this case, that the actual percentage of these evacuations for which A.Fs.
1.1220 were coded was 6:9, instead of the expected ten per cent.

By using statistics extracted from the Hygiene Reports as a control,
it is possible to assess with some degree of accuracy the present de-
ficiency during the eleven months of 1945 for which both sets of figures
are available. The following is the result of the comparison:

185

186 CASUALTIES AND MEDICAL STATISTICS

Hollerith Sample of A.Fs. I.1220 (alleged to be ten per cent.)} 13,381
Admissions disclosed by Hygiene Reports 166,678

Percentage of Hygiene Reports Admissions represented by
sample of A.Fs. I.1220 8-0

An explanation of the difference between this percentage and the
lower (6-9) obtained on the previous occasion is that it was acknowledged
at the time that A.Fs. I.1220 were incomplete due to very long term
cases still being in hospital. It can be assumed, therefore, that the
overall deficiency in the coding of these medical documents from
North-West Europe is in the region of twenty per cent.

It is interesting to compare admissions for some individual diseases
shown in the Hygiene Reports with the figures given in the Hollerith
Tabulations and assess the percentage of A.Fs. I.1220 coded. Here, the
following situation results.

Hygiene Hollerith | Percentages
Reports Tabulations | _ of A.Fs.

1.1220 coded
Bronchitis 1,902 203 10°6
Influenza 2,200 8 3°6
Rheumatic Fever 68 17 25°0
Psychiatric Disorders 55359 570 10°6
All Injuries 43,602 2,788 6-4
All Diseases 123,097 10,593 8-6
All Admissions 166,678 13,381 8-0

Assuming the statistics extracted from the Hygiene Reports are
correct, of the items shown above, Bronchitis and Psychiatric Disorders
were ten per cent. coded. Influenza and Injuries and All Diseases were
less than ten per cent. and Rheumatic Fever more than ten per cent.
The high percentage of Rheumatic Fever occasions no surprise having
in view the comparatively small number of admissions. What is sur-
prising is the relatively small percentage of coded cases of Influenza.
It is possible that some of these cases, initially diagnosed and included
in the Hygiene Reports as Influenza, were finally diagnosed as Common
Cold, Bronchitis, etc., but the number cannot be very high.

It cannot, however, be assumed that all the statistics extracted from
the Hygiene Reports are, in fact, correct. These reports were compiled

THE ARMY MEDICAL SERVICES 187

from statistical and other information produced, initially, by medical
units. There is no doubt that the following data are substantially
correct:

(i) Total Admissions for Diseases.

(ii) Total Admissions for Injuries.

(iii) Total Admissions.

As regards individual diseases, however, changes in diagnoses are
fairly common. On admission to a medical unit, a patient is provisionally
diagnosed. This diagnosis is entered on his records and may subse-
quently be amended when a firm diagnosis is made. If the firm diagnosis
was not made before the statistical returns are sent, it follows that the
provisional diagnosis was included in the Hygiene Report. It is doubtful
whether all amendments to provisional diagnoses were notified, or, if
they were, amendments made to Hygiene Reports. In one theatre, it is
known that amendments to returns were not made, if indeed they were
received at General Headquarters, until after the cessation of hostilities.

A comparison of the disease rate (hospital admissions only) for 1945
with that in 1946 reveals that the latter is greater. This is undoubtedly
chiefly due to the figure for 1946 including all cases of Venereal Diseases
whether or not they were treated in hospital. It is understood that the
majority of these patients were treated in other types of medical units.
If it is adjusted accordingly, the rate for 1945 will exceed that for 1946.

Landings on the Normandy beaches began in June 1944, and statistics
prepared from the Hollerith tabulations have been produced from July
1944. Because monthly strengths figures of British Troops operating
in North-West Europe were not maintained at the appropriate branch
of the War Office, monthly rates of admissions could not be calculated.
Quarterly strengths were, however, available. From these mean
strengths were calculated and equivalent annual rates for each quarter
computed. Such admission rates for the main diseases and disease
groups are included in Table 23. Therein, also, are similar rates of
admissions for injuries, sub-divided as to whether or not they were
caused by enemy action and ‘cause not known’. In this section, too,
admissions for certain disease and disease groups are analysed.

Hygiene Reports cover information from February 1945 to December
1945. For February, March and April, statistics relating to admissions
to hospital of injuries and certain diseases only, are available. From
May, in addition, are rates of admissions to all medical units on account
of other diseases. Mean monthly rates are available from these returns.
The strengths on which these were based differ only slightly from the
mean quarterly strengths used in computing rates based on Hollerith
tabulations. Here again, analyses of some disease and disease groups
are included. Monthly rates are calculated here per 100,000 strength.

7*CMS

188 CASUALTIES AND MEDICAL STATISTICS

This is contrary to the usual practice obtaining for other tabulations
herein, where rates are quoted at per 1,000 strength. This deviation
was prompted by the fact that monthly admissions for some diseases
were so few, and is permissible because of the large population at risk.
Had rates been based on 1,000 strength, such admissions would be
shown as ‘o-oo’ per 1,000 strength. By calculating them at 100,000
strength, a few admissions on account of, in many cases, important
diseases are brought out in their true perspective and trends shown.

ADMISSIONS

Rates of admissions to hospital based on tabulations produced by
the Hollerith Section of the War Office are given in Table 23. These
are equivalent annual rates based on admissions for the six quarters
from July 1944 to December 1945.

The disease rates recorded for the first two quarters were lower than
those for the remainder of the period. This was not entirely unexpected
as the Army which invaded France was a highly selected one, probably
the fittest, physically, which has ever left England. No doubt, with the
passage of time, it became diluted with troops who were less fit and
this, to some extent, might explain the increase in admissions during
1945. The increase was also partly due to the rising incidence of ad-
missions on account of venereal diseases. The lowest recorded rate of
admissions for diseases was 127 per 1,000 in the last quarter of 1944.
The highest was in the last quarter of 1945 at 176 per 1,000. Rates did
not increase in each quarter for, in 1945, the first quarter produced a
rate of 174, which was slightly lower than that for the final quarter. In the
second quarter of that year it fell to 150 and rose in the penultimate
quarter to 157.

As anticipated, the highest rate of admissions for injuries occurred
during the first stages of the invasion. A rate of 132 per 1,000 for all
types of injuries in the first quarter was succeeded, finally, by 57 in the
quarter which saw the end of the fighting in Europe. In the last quarter,
when all injuries were of the N.E.A. classification, the rate of admissions
was 22.

The quarter July to September, 1944 also saw the peak rate for all
admissions at 263 per 1,000. This was followed by the lowest recorded
rate of 178. For the first quarter of 1945 a rate of 245 was reported.
This was succeeded by rates of 207, 179 and 196 per 1,000.

DISEASES OF THE DIGESTIVE SYSTEM

Among individual diseases and disease groups, the highest
number of admissions over the eighteen months under review was
recorded by Diseases of the Digestive System. Apart from the first

THE ARMY MEDICAL SERVICES 189

quarter, when the E.A.R. was 30, rates varied slightly between 15 and
20 per 1,000. Expressed as percentages of total admissions for diseases,
the peak rate in the first quarter represented twenty-three per cent.
and the lowest in the first quarter, nine per cent. The E.A.R. for 1945
was 18 per 1,000, some eleven per cent. of disease admissions. A break-
down of admissions for this system is given below.

North-West Furope, 1944-45
Admissions to Hospitals for Diseases of the Digestive System
E.A.Rs. per 1,000 Strength and Relative Rates

Source: Hollerith Tabulations

1944 1945 1945
QUARTER
Ist 2nd grd 4th sth 6th Equive:
lent
1. Equivalent Annual July- | Oct.- | Jan— | Apr.— | July- | Oct.- | Annua

Rates Sept. | Dec. | Mar. | June | Sept. | Dec. | Rates
Gastric Ulcers . , 0°03 | 0°22] 0°27] 0-05 _ 0°13 | ovr
Duodenal Ulcers : 0°13 | 0°22 109 | 0°79 | 0°16} 0°32] 0°59
Peptic Ulcers,

Unspecified o-'or — a 0°05 _ 0°06 0°03
Perforation of Ulcer . 0:02 | 0:06 _ 0°05 | 0°06] 0-04 | 0:04
Dyspepsia and

Gastritis 2°75 3°26 | 3°66 2°52 2°51 2°34] 2°76
Hernia. . - | 3°34] 4°38] 3°71 | 3°68 | 4°47] 4°93 | 4°20
Haemorrhoids . : 2°84 | 2:81 2°46 3°26 2°02 2°08 2°46
Appendicitis Fi 5°91 6:80 | 6°77 | 6°35 6°65 3°12 5°72
Other Causes. ~ | 14°94 140 | 2:29 1°73 1°53 2°21 1°94

Totals : - | 29°97 | 19°15 | 20°25 | 18-48 | 17°39 |] 15°25 | 17°84
Percentages of total

admissions for

diseases - 23 15 12 12 I 9 .33
2. Relative Rates
Gastric Ulcers o-10 ris 1°33 0°27 _ 0°85 0°62
Duodenal Ulcers 0°43 rig 5°38 4°27 0°92 2°10 3°31
Peptic Ulcers,

nspecified - < 0°03 _- _- 0°27 _ 0°39 | O°17
Perforation of Ulcer . 0:07 | O°31 _— 0°27] 0:29] 0°39] 0:22
Dyspepsia and

Gastritis by : 9°18 | 17-02 | 18-07 | 13°64 | 14°43 | 15°34 | 15°46
Hernia. 5 » | tre1g | 22°87 | 18-32 | 19°91 | 25°70 | 32°33 | 23°53
Haemorrhoids & z 9°4! 14°67 | 12-15 | 17°64 | 11°62 | 13°64 | 13°78
Appendicitis =. - | 19°72 | 33°51 | 33°43 | 34°36 | 38-24 | 20°46 | 32-04
Other Causes. - | 49°85 7°31 | 11°31 9°36 | 8-80 | 14°49 | 10°87

Totals . . . [100 100 100 100 100 100 100

Numerically, the most important contributory cause was APPENDI-
citis. Rates of admission except for the first and last quarters are notable
for their slight variation of from 5-9 to 6-8 per 1,000. In the last

190 CASUALTIES AND MEDICAL STATISTICS

quarter the rate fell by fifty per cent. to 3-1. When admissions for
appendicitis are expressed as a percentage of the total admissions for
the disease group, in the first and last quarters they represent twenty per
cent. and during the others between thirty-three and thirty-eight per
cent. In 1945 as a whole, the rate was 5-7 per 1,000 which represented
thirty-two per cent. of the total admissions for Diseases of the Digestive
System.

Next in importance to appendicitis were HERNIAS. Admissions
ranged from 3:3 per 1,000 in the first quarter to 4-9 in the last and
were eleven and thirty-two per cent. of all admissions for the Group.
The Equivalent Annual Rate for 1945 was 4°2, twenty-four per cent. of
the total.

DYSPEPSIA and GASTRITIS which, in 1945, recorded an E.A.R. of 2:8
per 1,000 showed a variation in admissions of 1-3 over the six quarters.
Rates increased from 2-8 in the first quarter to 3-7 in the third, then
decreased each quarter to 2-3 in the last. Admissions for the first quarter
were nearly ten per cent. of the total for the group; in the third quarter,
they were eighteen and in the last, fifteen per cent. The average for
1945 was fifteen per cent of the total.

Rates of admission on account of HAEMORRHOIDS were 2-8 in the
first quarter. They were at their peak of 3-3 in the fourth and fell to
2:1 in the last quarter. The E.A.R. for 1945 was 2°5 per 1,000, approxi-
mately fourteen per cent. of the total admissions for the group.

ULCERS contributed an E.A.R. of 0-77 per 1,000 in 1945; of these
approximately four-fifths were DUODENAL, one-fifth GasTRic, with a
very few unspecified. Throughout the eighteen months, the highest
rate of admissions occurred in the first quarter of 1945 and the lowest
in the third quarter of the same year. Rates ranged from 0-19 to 1-36
and were slightly under five per cent. of the total admissions for the
group. An analysis of Perforated Ulcers reveals that, in the first
quarter, the rates of Gastric to Duodenal Ulcers were as 2: 1; in
the second and fifth, all were Gastric, and in the fourth and sixth
quarters all were Duodenal Ulcers.

The rate of admissions of 14:94 per 1,000 during the first quarter
against ‘Other Causes’ calls for comment. This high rate was due to
an outbreak of enteritis in August 1944. It rapidly subsided and, in
September, admissions on this account were only slightly above normal.

DISEASES OF THE EAR, NOSE AND THROAT

Next to Diseases of the Digestive System in numerical importance
came Diseases of the Ear, Nose and Throat. The trend of admissions
was contrary to that registered by Diseases of the Digestive System,
admission rates for which, on the whole, decreased over the period.

THE ARMY MEDICAL SERVICES 191

Admissions for Diseases of the Ear, Nose and Throat increased from
7 per 1,000 in the first quarter to 23 in the last, an increase of over
two hundred per cent. In 1945, the E.A.R. was 21 which represented
nearly thirteen per cent. of the total disease admissions for that year.
Over the whole period of eighteen months, the percentage of admissions
for disease was only slightly lower at under twelve.

Below is an analysis of admissions for diseases of the Ear, Nose and
Throat.

North-West Europe, 1944-45
Admissions to Hospitals for Diseases of the Ear, Nose and Throat
Equivalent Annual Rates per 1,000 Strength and Relative Rates

Source: Hollerith Tabulations

1944 1945 1945
QUARTER
Equiva-
Ist and 3rd 4th sth 6th lent
Annual
1. Equivalent Annual July- | Oct.-| Jan.—| April- | July- | Oct.-| Rates
Rates Sept. | Dec. | Mar. | June | Sept. | Dec.

Otitis Media Si 1
Tonsillitis . 6 : 3°20 | 6-or | 14°15 | 13°70 | 13-20 | 16°23 | 14°32
Other Diseases . 2

Totals e 3 7°16 | 12°24 | 22-01 | 20°42 | 18-98 | 23-30 | 21°18

Percentages of total
admissions for
diseases . é. . 5 10 13 14 12 31 13

2. Relative Rates

Otitis Media. . | 25°84 | 19°69 | 9°90 | 9-50] 6°32] 7°71 8-32

Tonsillitis . 7 - | 44°69 | 49°10 | 64-29 | 67-09 | 69°55 | 69-66 | 67-67

Other Diseases . + | 29°47 | gr-21 | 25-81 | 23-41 | 24°13 | 22°83 | 24-01
Totals A « [100 100 100 100 100 100 100

TONSILLITIS caused admissions which, on the average, were over
sixty per cent. of the total for this disease group. Rates increased from
3 in the first quarter to 16 per 1,000 in the last and represented from
forty-five to seventy per cent. of group admissions. The Equivalent
Annual Rate for 1945 was 14 per 1,000.

The rate for OTITIS MEDIA increased in the second quarter from
1-85 to 2-41 and then decreased to a final rate of 1-78 per 1,000. The
E.A.R. for 1945 was 1°76 per 1,000, some eight per cent. of the total
admissions for the group.

192 CASUALTIES AND MEDICAL STATISTICS

VENEREAL DISEASES

An analysis of admissions to hospitals on account of Venereal Diseases
follows. It is stressed that these figures relate to those treated in hospital
only, for the majority received treatment in other medical units.

North-West Europe, 1944-45
Admissions to Hospitals for Venereal Diseases
E.A.Rs. per 1,000 Strength and Relative Rates

Source: Hollerith Tabulations

1944 1945 1945
Equiva-
Ist 5th 6th lent
Annual
1. Equivalent Annual July- July- | Oct.- | Rates
Rates Sept. Sept. | Dec.
Gonorrhoea e . riz 11-18 | 10°52 | 9°24
Syphilis. ; % 0°81 7°14 | 11°23 | 5°56
Soft Chancre . . | oro2 orn | 0°26 | 0°18
Other Causes. 2 o'13 3°82 3°70 | 2°94
Totals . Ep 2°13 22°26 | 25°71 | 17°92
Percentages of total
admissions for
diseases . e ‘ 2 14 15 11
2. Relative Rates
Gonorrhoea s - | 54°93 | 78:20 | 66°43 | 61°64 | 50°25 | 40°92 | 51°56
Syphilis . diet . | 38-03 | 14°33 | 16-21 | 16-50 | 32°09 | 43°68 | 31-03
Soft Chancre . : 0°94 _- 1°59 reir 0°49 ror 1°00
Other Causes. . 6-10 | 7°47 | 15°77 | 20°75 | 17°17 | 14°39 | 16°41
Totals 2 « [100 100 100 100 100 100 100

As might be expected, the rate of admissions for this group of
diseases was lowest in the first quarter at 2 per 1,000. Admissions
increased to 26 in the last quarter. In the second and fourth quarters, the
rate was slightly under 10 per 1,000, in the third quarter it was 14, with
22 and 26 in the last two quarters. Expressed as a percentage of the
total admissions for diseases, admissions for Venereal Diseases were
two per cent. in the first quarter, 8, 8 and 7 respectively for the next
three and, for the two final quarters 14 and 15 per cent. The E.A.R.
for 1945 was 18 per 1,000, some eleven per cent. of the total admissions
for diseases.

Of the individual diseases of this group, GONORRHOEA caused most
admissions at rates which rose from 1 to 8 in the second quarter, and to
a peak of 11 per 1,000 in the last two quarters. This represented a
variation of from forty-one to seventy-eight per cent. of the total

THE ARMY MEDICAL SERVICES 193

admissions for Venereal Disease. The E.A.R. for 1945 was 9 per 1,000
which was slightly over one half that for the whole group.

The rate for SYPHILIS was also comparatively low in the first quarter
at slightly under 1 per 1,000. It increased to 2-2 by the third quarter
and fell to 1-6 in the fourth increasing considerably to 7 and 11 in the
two final quarters. The rates were equal to from fourteen to forty per
cent. of the total admissions for Venereal Diseases. It is of interest to
note the high rates of Syphilis in the last two quarters as compared with
those for Gonorrhoea. Indeed, in the last quarter, admissions for
Syphilis were forty-four per cent. of the group as compared with forty-
one per cent. for Gonorrhoea. The reason for this, of course, is that a
considerable number of cases of Gonorrhoea were treated in other medi-
cal units. The Equivalent Annual Rate for 1945 was 5-6 per 1,000, which
represented slightly under one-third the total rate for the group.

Admissions for SOFT CHANCRE were extremely few, ranging from a
rate of 0-02 in the first quarter to 0:26 in the last. There were no
admissions from this cause during the last quarter of 1944. The E.A.R.
of 0-18 per 1,000 in 1945 was one per cent. of the total for the group.

DISEASES OF THE SKIN

Admissions for Diseases of the Skin accounted for eight to twelve
per cent. of the total admissions for diseases. Rates increased from
10 per 1,000 in the opening quarter to 18 in the first six months of
1945 and then declined to 14 in the final half year. The E.A.R. for 1945
was 16 per 1,000 representing slightly under ten per cent. of the disease
total. The following is a breakdown of admissions for this group.

North-West Europe, 1944-45
Admissions to Hospitals for Diseases of the Skin

E.A.Rs. per 1,000 Strength and Relative Rates
Source: Hollerith Tabulations

1944 1945 1945
QUARTER
Equiva-
Ist and grd 4th th 6th lent
Annual
1. Equivalent Annual July— | Oct.- | Jan— | Apr.- | July- | Oct— | Rates
Rates Sept. | Dec. | Mar. | June | Sept. | Dec.
Boils e 1-51 1°80 1°80 1°94 1-91 1°56 1°80
Carbuncles 1°26 | 0°95 | 0°98 | 0°73] 0°76] 0°78] 0°81
Dermatitis 1°85 3°71 5°35 5°93 4°14 | 4°22] 4°92
Eczema. is S 0:77 | 0°67 1°04 | 0°73 | O-71 0°52 | 0°75
Impetigo . if iu 2:70 | 3°26| 3°71 2°99 1°25 1°62 | 2°42
Warts , 3 0°16 | 0-90 1°31 1°57 | 1°53 1°36 1°44
Other Diseases . 2:20 | 2°02 3°55 3°57 | 2°94 | 3°70] 3°41
Totals i . | ro°45 | 13°31 | 17°75 | 17°48 | 13°25 | 13°76 | 15°56
Percentages of total
admissions for
is 8 10 10 12 8 8 9

194 CASUALTIES AND MEDICAL STATISTICS

North-West Europe, 1944-45
Admissions to Hospitals for Diseases of the Skin
E.A.Rs. per 1,000 Strength and Relative Rates

Source: Hollerith Tabulations

1944 1945 1945
QUARTER

Equiva-
Ist and grd 4th sth 6th lent

Annual
July- | Oct.- | Jan.— | Apr.- | July- | Oct.- | Rates

2. Relative Rates Sept. | Dec. Mar. June | Sept. Dec.
Boils ~ A - | 14°48 | 13°50 | 10-15 | ri-rr | 14°40 | 11°32 | 11°59
Carbuncles 3 . | 12-01 TNT 5°54] 4:20] 5°76 5°66] 5-21
Dermatitis iM « | 17°73 | 27°85 | 30°15 | 33°93 | 31°28 | 30°66 | 31°63
Eczema. : + | 7°34 | 5°06] 5°85] 4°20] 5°35] 3°77] 4°85
Impetigo . 3 « | 25°84 | 24°47 | 20-92 | 17°12 | 9°47 | 11°79 | 15°54
Warts . * 5 1°56 6°75 7°38 gor | 11°52 9°91 9 25
Other diseases . . | 21°04 | 15+19 | 20°00 | 20°42 | 22°22 | 26°89 | 21-92
Totals . + [100 100 100 100 100 100 100

Of individual diseases, DERMATITIS caused most admissions. Rates
varied from 1-85 per 1,000 in the first quarter to a peak of 5-93 in the
fourth and declined to 4-22 in the last quarter. These admissions
represented eighteen, thirty-four and thirty-one per cent. of the res-
pective quarterly admissions of the group. The E.A.R. for 1945 was
4°92 equal to thirty-two per cent. of the group admissions.

Admissions for IMPETIGO commenced at 2-7 per 1,000, rose to 3°7 in
the third quarter and declined to 1-6 in the final period. As percentages
of total admissions for skin diseases, they were twenty-six, twenty-one,
and twelve respectively. The Equivalent Annual Rate for 1945 was 2-4,
nearly sixteen per cent. of the group total.

Rates for BOILS were very steady, ranging from 1°5 in the initial
quarter to a peak of 1-g in the fourth and fifth quarters. In the final
period the rate was 1-6 per 1,000. Admissions were, on the average,
slightly under twelve per cent. of the total for Skin Diseases. In 1945
the E.A.R. was 1-8 per 1,000.

Admissions for waRTS during the first quarter were comparatively
low at 0-16 per 1,000. They increased to o-g in the second quarter and
to 1-3 in the third. This was followed by 1-6, 1-5 and, finally, 1-4 per
1,000. The E.A.R. for 1945 was 1:44 which represented nine per cent.
of the total admissions for this group.

Rates for CARBUNCLES varied from 1-26 in the first quarter to 0-73 in
the fourth. The E.A.R., at 0-81 per 1,000, represented five per cent.
of the group.

ECZEMA was responsible for admission rates which ranged from 1-04
in the third quarter to exactly one half in the last. In 1945 the E.A.R.
of 0-75 was slightly under five per cent. of the total for the group.

THE ARMY MEDICAL SERVICES 195

‘Others’ at 3 per 1,000 represented a large number of individual
diseases, admissions for which were too few for rates to be calculated.

DISEASES OF THE MUSCULO-SKELETAL SYSTEM

Admissions on account of this group of diseases varied little during
the six quarters under review. The lowest rate was 10 per 1,000 (in
the last quarter) and the highest 14 (in the third quarter). These rates
represented six and eight per cent. of the total admissions for disease
during those quarters. The Equivalent Annual Rate for 1945 was 12
per 1,000 equal to some seven per cent. of all disease admissions.

The following is a breakdown of this group to component diseases.

North-West Europe, 1944-45
Admissions to Hospitals for Diseases of the Musculo-Skeletal System
E.A.Rs. per 1,000 Strength and Relative Rates

Source: Hollerith Tabulations

1944 1945 1945
QUARTER
Equiva-
Ist and 3rd 4th 5th 6th lent
Annual
1. Equivalent Annual July- | Oct. | Jan.— | Apr.- | July— Oct.-| Rates
Rates Sept. | Dec. | Mar. | June | Sept. Dec.
Disease of the Joints:
Synovitis 162] 48] 1°81 1°68] 1-15 104 | 1°42
Arthritis 0°34 | 0°38 | 0°49 | 0°68 | 0°44] 0°20] 0°45
1.D.K.* 1°85 1°53 1°26] 2°73 2°62 2-14] 2°19
Others . 0°45 | O'71 0:60 | 0:26] 0°44] 0-20] 0°38
Diseases of the Bone . 0:23 | 0°44] 0°33 | 0°32] 0-44] 0°20] 0°32
Diseases of the Spine . 0°07 | 0:27] 0°22] o-2r 0°16 | 0°13 0-18
Diseases of the Muscle | 0-02 _ 0°16 | ovrr | 0-05 | 0°07] o-10
Diseases of Fasciae,
Tendons, Tendon

Sheaths and Bursae:

Bursitis . : 0°87 | 0-17 | 0°88 | 0°32] 0:60} 0°52] 0°58
Others . y Orla 0°38 0°27 0°58 0°22 0°65 0°43
Diseases and
Deformities of the
Limbs:
Ingrowing Toenails. 0°18 | 0°38 | 0°16] 0-05] 0°33 o-20 | 018
Infected Fingers . 1°80 | 2°03 2-80 | 2:05 1°75 2°40 | 2°25
Others . . s 0°08 0°38 0°44 Or1s 0°27 0°39 O'31
Rheumatic
Conditions :t
Non-Articular i 3°17 | 3°13 3°73 3°10 | 2°29 1°62 2°69
Articular i é 0°26 0°49 0:99 o's8 0°65 0°65 0-72
Totals z . | rr-07 | 11°80 | 14°15 | 12°81 | 11°40 | 10°39 | 12°19
Percentages of total
admissions for
diseases : : 8 9 8 9 7 6 7

——_—_—

196 CASUALTIES AND MEDICAL STATISTICS

North-West Europe, 1944-45
Admissions to Hospitals for Diseases of the Musculo-Skeletal System
E.A.Rs. per 1,000 Strength and Relative Rates (contd.)

Source: Hollerith Tabulations

1944 1945 1945
Equiva-
lent
Annual
Rates
2. Relative Rates
Diseases of the Joints:
Synovitis 7 ‘ 11°49
Arthritis 3°63
1L.D.K.* 18°46
Others . é Fi 3°01
Diseases of the Bone . 2°63
Diseases of the Spine . 1°47
Diseases of the Muscles 0'77
Diseases of Fasciae,
Tendons, Tendon
Sheaths and Bursae:
Bursitis - . . 4°73
Others . 3°65
Diseases and
Deformities of the
Limbs:
Ingrowing Toenails. 1°58
Infected Fingers 18°55
Others . - 2°62
Rheumatic
Conditions:t
Non-Articular 21°57
Articular 5°87
Totals : : 100
es ee ee es ee

* I.D.K. includes: Internal derangement of knee and other joints. Subluxation of
intra-articular cartilage. Rupture of intra-articular cartilage. Ruptured crucial ligament
of knee, and Loose body.

t Rheumatic Conditions excludes Rheumatic Fever.

The highest rate of admissions was caused by Diseases of the JOINTS
which recorded an Equivalent Annual Rate in 1945 of under 5 per
1,000 which represented over one-third the total for the group. Of
these diseases, nearly one-half were attributable to I.D.K., the admis-
sion rates for which varied from 1-26 to 2°73 per 1,000. SYNOVITIS,
which accounted for one-quarter of the admissions for diseases of
the Joints was responsible for rates ranging from 1-04 to 1-81 per 1,000.
The rates for ARTHRITIS were lower from 0-20 to 0-68 per 1,000.

RHEUMATIC CONDITIONS accounted for the next highest rates of
admissions with an E.A.R. in 1945 of 3:4. Rates fluctuated between 2°3
in the last quarter to 4-7 per 1,000 in the third, representing from
twenty-two to thirty-three per cent. of the total admissions for the
group. By far the greater number of these admissions were due to the

THE ARMY MEDICAL SERVICES 197

non-articular type of rheumatism, which was responsible for rates
ranging from 1-6 to 3-7 per 1,000. The E.A.R. was 2-69 as against
that for the articular type at 0-72.

Next in numerical importance were Diseases and Deformities of the
Lims, admissions for which ranged from 2:06 in the first quarter to a
peak of 3-40 in the third and to 2-99 in the final quarter. These repre-
sented nineteen, twenty-four, and twenty-eight per cent. respectively
of the total admissions for the group. Of these admissions, four-fifths
were due to Infected Fingers and nearly ten per cent. to Ingrowing
Toenails. The E.A.R. for 1945 was 2°74 per 1,000, and twenty-three
per cent. of the group admissions.

More than one-half of the admissions on account of Diseases of the
FASCIAE, TENDONS, TENDON SHEATH and BURSAE were for BURSITIS.
Admissions for this sub-group varied over the six quarters from 0-6
per 1,000 in the second quarter to 1-2 in the last. The E.A.R. in 1945
was slightly over 1 per 1,000 representing some eight per cent. of the
total admissions for diseases of the Musculo-Skeletal System.

The remaining diseases of the group each of which contributed ad-
mission rates at less than 0-5 per 1,000 were Diseases of the BONE, at
0°32. Diseases of the SPINE at 0:18 and Diseases of the MUSCLE at 0-1
per 1,000 strength.

DISEASES OF THE GENITO-URINARY SYSTEM

The rates of admission for this group of diseases increased steadily
quarter by quarter from 2-9 per 1,000 initially to a final rate of 17-2,
representing from two to ten per cent. of the total admissions for dis-
eases. The Equivalent Annual Rate for 1945 was slightly under 12 per
1,000, being some seven per cent. of the admissions for disease.

The following is an analysis of this group.

1988 CASUALTIES AND MEDICAL STATISTICS

North-West Europe, 1944-45
Admissions to Hospitals for Diseases of the Gentto-Urinary System
E.A.Rs. per 1,000 Strength and Relative Rates

Source: Hollerith Tabulations

1944 1945 1945
QUARTER
Equiva-
Ist 2nd grd 4th sth 6th lent
Annual
1. Equivalent Annual July- | Oct.- | Jan.— | Apr.- | July- | Oct.- | Rates
Rates Sept. | Dec Mar. June | Sept. | Dec
Pyelitis 0°23 0°17 | 0°38 | 0°32 | 0°35 | 0°46] 0°32
Renal Colic 4 018 | 0°17 | 0°22] 0°32] 0°24] 0°29] 0°20
Other Diseases of the
Kidney . 0°18 | 0°28 | 0:27] 0°26] 0°38 | 0°48] 0°33
Cystitis. 4. 0°18 | 0°39 | 0°55 | 0°42] O50] 0:65] 0°45
Urethritis N.V. . 2 o-19 | 2-19 | 2°46] 3°22] 4°54] 6°83] 4:69
Other Diseases of the
Urethra < 0°17 | 0:06 | ovr ovrr 0°24 | 0°34] 0°23
Urinary Disorders 0°54 o'sr o's5 0°58 0-79 0°98 0:68
Balanitis N.V. OrlL 0°67 1°04 1°06 1°27 1°86 1-28
Varicocele 0:06 | 0°17 0705 | 0:26] o-13 org | o'10
Hydrocele org _- 0°16 Orlr 0°25 0°38 0°26
Orchitis N.V. . 0°06 | orrr 0°05 Ovll Ovlr 0°13 | O-09
Epididymitis N.V. 0°46 | 0:73 0°93 0°85 | ons 1°53 1°05
Other Diseases . 0°40 112 1°81 1°73 2°16 3°12 2°14
Totals 2°90 | 6°57 | 8°58] 9°35 | 12°11 | 17°20] 11°82
Percentages of total
admissions for
diseases . 2 5 5 6 8 10 7
2. Relative Rates
Pyelitis 7°96 2°57 | 4°46 | 3°40 1°81 1°89 | 2°71
Renal Colic 5 6:09 2°57 2°55 3°40 0°90 0°75 1°70
Other Diseases of the
Kidney . 6°32 | 4°27 3°18 | 2°82 | 4:05 Ist 2°80
Cystitis 6:32 | 5°98 | 6°37] 4°52] 3°15 2°26 3°80
Urethritis N.V. . < 6-56 | 33°33 | 28°66 | 34-46 | 41-44 | 48-30 | 39°68
Other Diseases of the
Urethra 5 i 5°85 | 0°85 1°27 1°13, 2°25 2°64 1°95
Urinary Disorders 18-50 7°69 6°37 6-21 4°50 6°04 5°75
Balanitis N.V. 3°75 | 10°26 | 12°10 | 11°30 | 12°16 8-68 | 10°83
Varicocele 2¢1 2°57 | 0°64] 2°82] 0°45 _ 0°85
Hydrocele 4°68 _ 1g 1°13 1°81 3°40 2°19
Orchitis N.V.. 2-11 rer} 0°64 1°13 | 0-90 | 0°38] 0°76
Epididymitis N.V. 1§°93 | tr'tr | 10°83 g:04 | 7°21 9°06 | 8-88
Other Diseases . 13°82 | 17-09 | 21-02 | 18-64 | 19°37 | 15°09 | 18°10
Totals 100 100 100 100 100 100 100

THE ARMY MEDICAL SERVICES 199

Diseases of the KIDNEY accounted for admissions at an Equivalent
Annual Rate in 1945 of 0-85 per 1,000 which represented some seven
per cent. of the total admissions of the group. Over one-third were
attributable to PYELITIS and one-quarter to RENAL COLIC.

After the first quarter when the rate was 0-18, admissions for CYSTITIS
varied but little and ranged between 0-4 and 0-6 per 1,000. The E.A.R.
in 1945 was 0°45 per 1,000, equal to just under four per cent. of group
admissions.

Admissions for N.V. URETHRITIS increased quarterly from 0-2 per
1,000 in the first quarter to 6-8 in the last. The rate for 1945 was 4-7,
some forty per cent. of the total admissions. Other Diseases of the
URETHRA were responsible for comparatively few admissions at 0-23 per
1,000.

The rates of admissions on account of URINARY DISORDERS in the
first four quarters were particularly stable ranging from 0-51 to 0-58
per 1,000. In the last two quarters they increased to 0-79 and 0-98.
The E.A.R. for 1945 was 0-68.

Admissions for N.V. BALANITIS, like Urethritis, increased each
quarter, although the rate of increase was not so pronounced. Rates
were o-11 in the first quarter, and 1-86 in the last. The 1945 rate of
1:28 per 1,000 was some eleven per cent. of the total admissions for
the group.

The rates for VARICOCELE were comparatively low at 0-10 per 1,000
as were those for HYDROCELE at 0:26, N.V. ORCHITIS at 0-09 and N.V.
EPIDIDYMITIS at 1-05.

MENTAL DISEASES

Admissions for Mental Diseases were highest in the first of the six
quarters under review at 14 per 1,000. Rates decreased gradually until
in the last quarter it was slightly over 4. These rates represented
eleven and two per cent. respectively of all admissions on account of
disease. The Equivalent Annual Rate for 1945 was 6-75 per 1,000, being
four per cent. of the total disease admission rate.

An analysis of admissions for this group follows. It must be men-
tioned that in this, as well as in other tabulations in this sub-section,
where no admissions are shown against any disease, it does not neces-
sarily follow there were, in fact, no admissions for that particular
disease, but that none were in the ten per cent. sample made for coding
purposes, of which mention has already been made.

200 CASUALTIES AND MEDICAL STATISTICS

North-West Europe, 1944-45
Admissions to Hospitals for Mental Diseases
E.A.Rs. per 1,000 Strength and Relative Rates

Source: Hollerith Tabulations

19.44 1945 1945
QUARTER
Equiva-
Ist and 3rd 4th 5th 6th lent
Annual
1. Equivalent Annual July- | Oct.- | Jan.- | Apr.- | July- | Oct.— | Rates
Rates Sept. | Dec. | Mar. June | Sept Dec.
Psychoses:
Manic Depressive Orl7 oO 0:06 or21 0°32 o'19 org
Schizophrenia o-'21 0°16 | 0:27] 0°53 | 0°27] 0°38 | 0°36
Paranoid State _ _ _ _ 0°05 _ oor
Others . 0°07 _— _ _ _ _ _—
Psychoneuroses:
Anxiety State 10°80 | 7°71 9°06 3°83 2°59 2°40] 4°48
Hysteria 2°38 1°90 1°92 0°63 0°59 o'7r 0°96
Others . 0°13 | 0°22 | 0°06] 0-05 | 0°22 {| 0°06] o-10
Psychopathic
Personality . O's51 0°34 | 0°55 | 0°47] 0°65 | 0°13 | 0°46
Mental Deficiency o-2r 0-22 | o-10}] 0-16] 0°27 3 | o-17
Other Disorders. 0-02 | 0:06 | — 0-10 _ 0-02
Totals 14°50 | 10°67 | 12-02 5°99 | 4°96] 4:02 | 6°75
Percentages of total
admissions for
diseases 11 8 7 4 3 2 4
2. Relative Rates
Psychoses:
Manic Depressive 1°20 | 0°52 | 0°46 3°51 6-52 | 4°84] 2°87
Schizophrenia 1°45 1°57 | 2°28] 8:77] 5:43] 9°68] 5°34
Paranoid State _ _ _ _ 1°09 _- 0°20
Others . 0°48 _ _ _ —_ _ --
Psychoneuroses:
Anxiety State 74°46 | 72°25 | 75°34 | 64°04 | 52°17 | 59°68 | 66-32
Hysteria 16°43 | 17°80 | 15-98 | 10°53 | 11°96 | 17°74 | 14°17
Others - 0-92 | 2°09] 0°46] 0°88] 4°35 1°61 1°44
Psychopathic
Personality, 3°52 | 3°14] 4°57] 7°89 | 13°04 | 3°23] 6°78
Mental Deficiency 1°45 2°09 | o°91 2°63 5°43 3°23 2°46
Other Disorders. o10 | 0752 _ 1°75 — = O°41
Totals 100 100 100 100 100 100 100

By far the greatest number of admissions were caused by ANXIETY
STATE. In the first quarter, admissions were at the high rate of 10-8 per
1,000. This figure was exceeded only by admissions for Malaria (13:8),
Diseases of the Digestive System (30) and Diseases of the Musculo-
Skeletal System (11). In the second quarter they had dropped to 7-7,

THE ARMY MEDICAL SERVICES 201

but increased to 9-1 in the third. During the fourth quarter, which saw
the last of the fighting in Europe, the rate had dropped to 3-8 and this
was followed by further declines to 2-6 and 2-4. Admissions over the
period represented a variation of from fifty-two to seventy-five per
cent. of the total diseases for the group. The equivalent annual rate for
1945 was 4°5 per 1,000, some two-thirds the group total.

Admission rates for HYSTERIA were also highest in the first quarter at
2°38. They declined until by the last quarter the rate was 0-71. The
E.A.R. for 1945 was I per 1,000, fourteen per cent. of the total for the
whole group.

In all, admissions on account of PSYCHONEUROSES over the whole
period were of the order of 7:5 per 1,000, some eighty-two per cent.
of the total group admissions. During 1945 the rate was 5-5, representing
seventy-two per cent. of group admissions. During the last two
quarters of 1945, when active operations in North-West Europe had
ceased, the rate of admissions were slightly over 3 per 1,000.

Following Anxiety State and Hysteria in numerical importance came
admissions on account of PSYCHOPATHIC PERSONALITY. Admissions
varied but little in the first five quarters from 0-34 to 0-65. In the last
quarter the rate fell from 0-65 to 0-13 per 1,000. The E.A.R. in 1945
was 0°46, some seven per cent. of the total admissions for the group.

In the psycHosEs sub-group, most admissions were caused by
SCHIZOPHRENIA with a range from 0-16 to 0:53 per 1,000. The 1945
rate was 0-36. Admissions for MANIC DEPRESSIVE state recorded an
E.A.R. of o-19 in 1945. There were few recorded admissions for
PARANOID state or for Other Psychotic Diseases. This sub-group
registered admissions in 1945 at a rate of 0-56 per 1,000, eight per cent.
of the total admissions for Mental Diseases.

Admissions for MENTAL DEFICIENCY registered an E.A.R. of 0-17 in
1945, under three per cent. of total group admissions.

DISEASES OF THE AREOLAR TISSUE

Admissions for diseases of the Areolar Tissue increased from 6 per
1,000 in the first quarter to 10 in the fourth and declined to under 8
in the last quarter. These represented five, seven, and four per cent.
respectively of the total admissions for diseases. The Equivalent Annual
Rate in 1945 was 8 per 1,000, some five per cent. of all disease admis-
sions.

Diseases of this group were coded under six headings. When the
ten per cent. sample of Hollerith cards for North-West Europe was
analysed it was found no admissions were recorded for Malignant
Tumours and Cysts, Subcutaneous Emphysema or for Other Diseases.
Figures for the three causes which registered admissions are as follows:

202 CASUALTIES AND MEDICAL STATISTICS

North-West Europe, 1944-45
Admissions for Diseases of the Areolar Tissue
E.A.Rs. per 1,000 Strength and Relative Rates

Source: Hollerith Tabulations

1944 1945 1945
QUARTER

Equiva-

Ist and 3rd 4th 5th 6th lent

Annual

x. Equivalent Annual July- | Oct.- | Jan.- | Apr.- | July- | Oct.- | Rates

Rates Sept. | Dec. | Mar. | June | Sept. | Dec.
Cellulitis . F - | 4°98 | 5°33 | 7°76] 8-61] 5:95 | 6:04] 7-11
Tumours and Cysts:
Benign and

Unspecified O12 O17 0°22 o'2r 0°32 o'21 0°24
Abscesses: Unspecified 0°83 0°62 | 0°76 1°10 1°26 1°35 1710

Totals 2 . 5°93 6-12] 8°74] 9°92] 7°53 7°60 | 8-45

Percentages of total
admissions for
disease . a Fee) 5 5 7 5 4 5

2. Relative Rates

Cellulitis . . | 83°98 | 87-16 | 88-78 | 86-77 | 78-99 | 79°44 | 84°18
Tumours and Cysts:

Benign and

Unspecified 2:06 | 2°75 2:50 | 2:12 2°80 | 2°86

re
Abscesses: Unspecified 13°96 | 10-09 | 8-75 | r1-11 | 16°

Totals é + [roo 100 100 100 100 100 100

As was only to be expected, the greatest number of admissions was
caused by CELLULITIS. Rates increased steadily from 5 per 1,000 in the
first quarter to g in the fourth, and then declined to 6 in the last two
quarters. As a percentage of total admissions for this group, they ranged
from seventy-nine to eighty-nine per cent. The E.A.R. was 7 per 1,000,
eighty-four per cent. of the annual admissions.

The rates of admission for Unspecified aBscEss varied from 0-62 in
the second quarter to a peak of 1-35 in the last. The E.A.R. of 1-1 was
thirteen per cent. of the group total. Benign and Unspecified TuMouRS
and cysts accounted for an admission rate of 0°24 per 1,000.

DISEASES OF THE MOUTH, TEETH AND GUMS

Admissions for this group of diseases increased nearly ten fold over
the eighteen months under review. The rate in the first quarter was
1:35 per 1,000 while that in the last was 12-72. The largest increase
was in the penultimate quarter when the rate rose from 4 to nearly
11 per 1,000. Admissions were from one to seven per cent. of those for

THE ARMY MEDICAL SERVICES 203

all diseases. In 1945, the E.A.R. of 9:57 was recorded, some six per
cent. of all disease admissions.
An analysis of these admissions follows:

North-West Europe, 1944-45
Admissions for Diseases of the Mouth, Teeth and Gums
E.A.Rs. per 1,000 Strength and Relative Rates

Source: Hollerith Tabulations

1944 1945
QUARTER
|Equiva-
and 3rd 4th sth lent
Annual
1. Equivalent Annual Oct.— | Jan.- | Apr.— | July- Rates
Rates Dec. | Mar. | June | Sept.
Vincent's Angina 0:67 | 0°86 1°37 | 3°62 3°21
Other Diseases of the |
Mouth . 0:06 | 0-31 0:26 | o-s5r 0°45
Gingivitis . 0°62 | 0°81 r2i 5°54 4°34
Other Diseases of the
Gums _ 0°05 _ _ 0-02
Diseases of the Teeth . 5 0°78 | 0-92 1°26 1°18 1°55
Totals 2°13 | 2°95 | 4°10 | 10°85 9°57
Percentages of total
admissions for
diseases 2 2 3 7 6
2. Relative Rates
Vincent’s Angina - | 42°74 | 31°58 | 29°32 | 33°33 | 33°33 | 34°98 | 33°52
Other Diseases of the
Mouth * s 4°03 2°63 | 10°34 | 6°41 | 4°69] 2°46] 4:70
Gingivitis . 16°93 | 28-95 | 27°59 | 29°49 | 51°04 | 51°23 | 45°39
Other Diseases of the |
Gums 0°81 _ 1°72 — _ — org
Diseases of the Teeth | 35°49 | 36°84 | 31°03 | 30°77 | 10°94 | 11°33 | 16-20
Totals . . [100 100 100 100 100 100 100

Admissions for VINCENT’s ANGINA increased quarter by quarter from
an initial rate of 0-58 per 1,000 to 4:45 in the final quarter. The largest
rise in rates occurred in the penultimate quarter when admissions
increased from 1-4 to 3:6 per 1,000. The 1945 rate was 32, approxi-
mately one-third of the total admissions for the group. Other Diseases
of the Mouth recorded an E.A.R. of 0-5 per 1,000.

GINGIVITIS caused rates of admissions which, like Vincent’s Angina,
increased each quarter. The rate in the first quarter of 0-2 was followed
by 0-6, 0-8 and 1-2. The ensuing quarter saw a four-fold rise to 5-5
per 1,000. In the final period, the rate was 6-5. Expressed as percentages
of total admissions for this group, these rates represented a range of

204 CASUALTIES AND MEDICAL STATISTICS

seventeen to fifty-one per cent. In 1945, the E.A.R. was 4.3, some
forty-five per cent. of the group total.

Diseases of the TEETH also were responsible for rates which increased
throughout the period, although the rises were not so spectacular as
those for Gingivitis or for Vincent’s Angina. Here, the admission rate
for the last quarter was three times that of the first, 1-44 per 1,000 as
against 0-48. In 1945, the rate was 1-55 per 1,000, some sixteen per
cent. of the group total.

DISEASES OF THE RESPIRATORY SYSTEM

Admissions for this group of diseases recorded increases in the
second and third quarters and thereafter a decline. Rates were 2-2
per 1,000, 5-9 and 7-4, followed by 4:4, 3:3 and 31, representing from
slightly under two to nearly five per cent. of all admissions for diseases.
The Equivalent Annual Rate for 1945 was 4:5, some two and a half
per cent. of disease admissions.

Hereunder is an analysis of admissions for this group:

North-West Europe, 1944-45

Admissions for Diseases of the Respiratory System
E.A.Rs. per 1,000 Strength and Relative Rates

Source: Hollerith Tabulations

1944 1945 1945
QUARTER
Equiva-
Ist 2nd 3rd 4th 5th 6th lent
Annual
1. Equivalent Annual July- | Oct.— | Jan— | Apr.- | July- | Oct.— | Rates
Rate Sept. | Dec. | Mar. | June | Sept. | Dec.
Bronchitis:
Acute . « < 0°47 1°55 2:09 | 0°87] 0°62] 0-59 104
Chronic a o'st 1°91 2°16 118 °"90 0°78 124
Unspecified. 5 0°59 1°37 2°09 1°63 0°44 0°59 1'20
Pleurisy . : ‘ 0°37 0°28 0°33 0°26 0°49 0°39 0°37
Other Diseases . : 0°27 o"79 o-71 0°47 0:82 O'71 0°68
Totals 4 y 2°21 5°90 | 7°38 | 4°41 3°27 | 3°05 | 4°53
Percentages of total
admissions for
diseases “ < 2 5 4 3 2 2 3
2. Relative Rates
Bronchitis:
Acute . 5 . | 21°27 | 26°27 | 28°32 | 19°72 | 18:96 | 19°28 | 22°96
Chronic . + | 23°08 | 32°37 | 29°27 | 26-76 | 27-52 | 25-49 | 27°37
Unspecified . « | 26°70 | 23°22 | 28°32 | 36-96 | 13°46 | 19°28 | 26-49
Pleurisy . : - | 16°74] 4°75 | 4°47] 5°90 | 14°98 | 12°75 | 8:17
Other Diseases . . | 12-21 | 13°39 | 9°62 | 10°66 | 25-08 | 23-20 | 15-01
Totals ‘ . [100 100 100 100 100 100 100

THE ARMY MEDICAL SERVICES 205

By far the greatest number of admissions was caused by BRONCHITIS.
Admissions commenced at 1-6 per 1,000, increased to 4:8 and 6-3, then
declined to 3-7 and 2-0 in the final two quarters. The Equivalent
Annual Rate of 3-5 per 1,000 was slightly over three-quarters the total
for the group. Chronic Bronchitis accounted for thirty-five per cent.
of all admissions for Bronchitis, and Acute Bronchitis for some thirty
per cent. ‘Unspecified’ Bronchitis, thirty per cent. of all Bronchitis
admissions, were other types of Bronchitis together with, possibly,
some acute and chronic cases.

Admissions for PLEURISY varied from 0-26 per 1,000 in the quarter
April to June, 1945, to 0-49 in the subsequent quarter. This disease
recorded an E.A.R. of 0-37 per 1,000, some eight per cent. of all ad-
missions for the group.

Admissions for OTHER DISEASES of the Respiratory System were 0-68
per 1,000, just fifteen per cent. of the group total.

DISEASES OF THE EYE

This group of diseases accounted for admissions at a rate of 2:5 per
1,000 in 1945. During the period under review, rates rose from 1-9 in
the first quarter to a peak of 4 in the third and declined to 1-9 in the
final quarter. Admissions for this group are analysed in the following

table.

North-West Europe, 1944-45
Admissions for Diseases of the Eye
Equivalent Annual Rates per 1,000 Strength and Relative Rates
Source: Hollerith Tabulations

1944 1945 1945
QUARTER
/Equiva-
1st and grd 4th sth 6th lent
Annual
1. Equivalent Annual July- | Oct.- | Jan.- | Apr.— | July- | Oct.- | Rates
Rates Sept. | Dec. | Mar. | June | Sept. | Dec.
Conjunctivitis . : 0°67 118 1-25 | O-71 0°82 | os8 | 0°84
Keratitis . ‘4 2 0:70 | 0°73 1°25 | 0°99 | oO°44| 0°58] 0°82
Iritis ae 5 z 0-05 | 0°28 | 0°34] 0°38] 0°05 | 0:07] o-ar
Blepharitis . - | 0:06 | orrr | 0°17] 0°16 _ 0:20] 0°13
Others. 2 x 0°43 | 0°62 1°03 | 0°44] 0°22] 0°45] 0°53
Totals ; ror | 2°92] 4°04] 2°68] 1°53 1°88 | 2°53

2. Relative Rates

Conjunctivitis . — . | 34°93 | 40°38 | 30°99 | 26°53 | 53°57 | 31°03 | 33°33
Keratitis . a - | 36°99 | 25-00 | 30°99 | 36°73 | 28°57 | 31°03 | 32°20
lritis . 3 2-40 | 9°62 | 8-45 | 14°29 | 3°57] 3°45 | 8:48
Blepharitis 4 : 3°08 | 3°85 4°22 | 6°12 _ 10°34 5°09
Others . si « | 23-60 | 21-15 | 25°35 | 16°33 | 14°29 | 24°15 | 20°90

Totals A + [100 100 100 100 100 100 100

206 CASUALTIES AND MEDICAL STATISTICS

CONJUNCTIVITIS and KERATITIS, with annual rates of 0-8 per 1,000
in 1945, together accounted for two-thirds of the admissions of this
group. In both cases the highest rate of 1-25 occurred in the third
quarter and the lowest in the final period. Admissions for IRITIS in-
creased from 0-05 per 1,000 in the first quarter to 0-38 in the fourth,
declining eventually to 0-07. The annual rate was 0-21. There were
no admissions in the fifth quarter for BLEPHARITIS which recorded an
annual rate of 0-13 per 1,000.

DISEASES OF THE NERVOUS SYSTEM

Admissions for this group of diseases increased by fifty per cent.
from the first quarter to the third (2 to 3 per 1,000), then declined until
by the sixth quarter, the rate was slightly less than that of the first.
The Equivalent Annual Rate for 1945 was 2:5 per 1,000.

An analysis of these admissions is given below.

North-West Europe, 1944-45
Admissions to Hospitals for Diseases of the Nervous System
Equivalent Annual Rates per 1,000 Strength and Relative Rates

Sources: Hollerith Tabulations

1944 1945 1945
QUARTER

Equiva-
Ist 2nd grd 4th sth 6th lent

Annual

1. Equivalent Annual July- | Oct.- | Jan.- | Apr.— | July- | Oct.— | Rates

Rates Sept. | Dec. | Mar. | June | Sept. | Dec.

Sciatica . ‘ é 0°64 1°06 1°00 102 0°89 0°58 0°87
Other Neuritis . , 0°16 | 0°34 | 0°39 | O17] O-nr o-19 | 0°22
Migraine . i £ 018 | 0-22] ovrr | 0:28 | 0°06] 0°07] 0°13

Other Diseases o!
uncertain Pathology 0702 | 0°06] o-rr 0:06 | 0°17 | 0:07 | oro

Effort Syndrome . 0°18 | 0:06} 0°28 | o°17]| 0°17 _ 0°16
Diseases of the

Cerebral Meninges . 0-12 | 0°06 _ _ orn o'19 | 0°08
Diseases of the Brain . Ovlr 0°22 | 0:06] 0:06 _ _ 0°03
Epilepsy . . 0°05 o-22 0°06 or17 O'17 o'13 o°13
Disorders of the

Cranial Nerves * 0°35 0°34 0°72 080 0°45 0°40 0°59
Other Diseases . A Ors _ 0°22 Orrr 0°22 o-19 0°18

Totals C é 1°96 | 2°58 2°95 2°84 | 2°34 1°82 2°49
2. Relative Rates
Sciatica . « | 32°69 | 41°31 | 33°96 | 36-00 | 38:10 | 32°14 | 35°26
Other Neuritis . 7 8-08 | 13°04 | 13°21 6:00 | 4:76] 10°71 8:67
Migraine . a : 9°23 8-70 3°77 | 10°00 2°38 3°58 5°20

Other Diseases o:
uncertain Pathology 1:16 | 2:17! 3:77! 2:00 | 7:14 1 3:58 | 3°58

THE ARMY MEDICAL SERVICES 207

North-West Europe, 1944-45
Admissions to Hospitals for Diseases of the Nervous System
Equivalent Annual Rates per 1,000 Strength and Relative Rates

Source: Hollerith Tabulations

1944 1945 1945
QUARTER
__—_—__ Equiva-
Ist grd 4th 5th 6th lent
Annual

Jan.— | Apr.— | July- | Oct.- | Rates

2. Relative Rates—cont.| Sept. Mar. | June | Sept. | Dec.

Effort Syndrome , 9°23 9°43 6:00 | 7°14 _ 6°36
Diseases of the

Cerebral Meninges . 615

Diseases of the Brain . 5°77 1°89 | 2-00 _ _ 1°16
Epilepsy . % f 2°69 1°89 | 6:00 | 7°14] 7°14] 5°20
Disorders of the
Cranial Nerves . | 17°69 24°53 | 28-00 | 19°05 | 21°43 | 23°70
Other Diseases . - | 7°34 7°55 | 4°00] 9°53 | 10°71 | 7°51
Totals . « [100 100 100 100 100 100

More than one-third of the admissions of this group of diseases were
due to sciatica, which recorded an Equivalent Annual Rate of 0-87 per
1,000 in 1945. Rates were lowest in the first and last quarters. Other
admissions for NEURITIS were one-fourth those for Sciatica.

Disorders of the CRANIAL NERVES followed Sciatica in numerical
importance with an E.A.R. in 1945 of 0-59 per 1,000, nearly one-quarter
of the total admissions for this group. Admissions for MIGRAINE which
were lower in the two final quarters, after the cessation of active opera-
tions, had an E.A.R. of 0-13, some five per cent. of the group total.

There were no recorded admissions for EFFORT SYNDROME in the last
quarter. During the other periods rates ranged from 0-06 to 0:28.
Admissions on account of Diseases of the CEREBRAL MENINGES registered
an Equivalent Annual Rate of 0-08, and those for Diseases of the BRAIN,
0°03. The E.A.R. of 0-13 per 1,000 in 1945 for EPILEPSY was five per
cent. the total admissions for this group.

DISEASES OF THE CARDIO-VASCULAR SYSTEM

This group of diseases accounted for admission rates ranging from
1-4 in the first quarter to 3-3 per 1,000 in the last. In 1945 the Equivalent
Annual Rate at 3 per 1,000, represented nearly two per cent. of all ad-
missions for disease. Admissions analysed according to Valvular Disease
of the Heart, Varicose Veins, and Other Diseases of the System are as
under.

208 CASUALTIES AND MEDICAL STATISTICS

North-West Europe, 1944-45
Admissions to Hospitals for Diseases of the Cardio-Vascular System
E.A.Rs. per 1,000 Strength and Relative Rates

Source: Hollerith Tabulations

1944 1945
QUARTER
1st and 3rd 5th 6th
1. Equivalent Annual July- | Oct.- | Jan.- July- | Oct.-
Rates Sept. | Dec. | Mar. Sept. | Dec.
Valvular Disease ti
of the Heart . H ovor 0706 | 0-05 0°05 _
Varicose Veins . - | 0°66] 1-40] 1°86 2°13 | 2°47
Other Diseases . ‘ 0°73 1°07 1°20 082 0:84
Totals ‘ 3 1-40 | 2°53 | 3°11 3°00 | 3°31
Percentages of
total admissions
for diseases. : 1 2 2 2 2
2. Relative Rates
Valvular Disease
of the Heart . i 0-72 | 2°37 | 1°61 _- 1°67 2738
Varicose Veins . =. | 47°14 | 55°34 | 59°81 | 65-95 67°87
Other Diseases . . | 52°14 | 42°29 | 38°58 | 34-05 | 27°33 3reis
Totals 100 100 100

VARICOSE VEINS were responsible for rates which increased from 0-66
per 1,000 in the first quarter to 2-47 in the last. The rate for 1945
was 2:07, nearly seventy per cent. of the total for the group. There
were very few admissions for VALVULAR DISEASE of the HEART which, in
1945, registered a rate of 0:03 per 1,000. There were no recorded
admissions in the second and last quarters of this year.

Of admissions for other diseases, less than one-third were caused
by Diseases of the veINS, other than Varicose Veins. The remainder
were on account of a wide variety of diseases comprising the balance of

the group.

PNEUMONIA

Admissions for Pneumonia were 0-6 in the first quarter. They rose
to 2 in the second and to a peak of 4 in the third (January to March).
Thereafter they varied but little at 2-6, 1-8 and 2-2 per 1,000. The
Equivalent Annual Rate in 1945 was 2-7. An analysis of admissions
for this disease is given below.

THE ARMY MEDICAL SERVICES 209

North-West Europe, 1944-45
Admissions to Hospitals for
E.A.Rs. per 1,000 Strength and Relative Rates

Source: Hollerith Tabulations

1944

1. Equivalent Annual
Rates

Acute Primary
and Lobar :
Broncho-Pneumonia .
Atypical Pneumonia
Other Types and
Unspecified .

Totals

2. Relative Rates

Acute Primary
and Lobar . . | 62°07
Broncho-Pneumonia . 6-90
Atypical Pneumonia . 6-90
Other Types and
Unspecified. « | 24°13

Totals

The E.A.Rs. for 1945 for ACUTE PRIMARY and LOBAR Pneumonia and
ATYPICAL Pneumonia differed very slightly at 0-81 and 0-82 per 1,000
respectively. Where, however, admissions for the former tended to
increase (0-98 to 1-30), those for the latter decreased (1-37 to 0°52).
These diseases were each responsible for approximately thirty per cent.
of all group admissions. Admissions for BRONCHO-PNEUMONIA with an
E.A.R. of 0°48 also tended to decline from 1-04 in the first quarter
of 1945 to 0-13 in the last.

DIPHTHERIA

The lowest rate of admissions for Diphtheria occurred during the
first quarter of the period under review. An initial rate of 0-08 per
1,000 increased to 2-08 in the second quarter and to 5-03 in the third.
The three closing quarters recorded rates of 1-47, 1°42 and 1-95 res-
pectively. The large increase in admissions in the second and third
quarters commenced in December 1944, rose to a peak in the following
month, and declined in February and March. By April admissions
were at a normal rate. Comparative monthly admissions with November
represented as 100 were:

210 CASUALTIES AND MEDICAL STATISTICS

December . . 183 January . . 300
February . . 266 March. » 200
April . . 83
The Equivalent Annual Rate for 1945 was 2-47 per 1,000.
Diphtheria was normally diagnosed, and coded, under the following
classifications: Laryngeal, Faucial, Nasal, Cutaneous, Paralysis and
Gravis. A large number of cases were, however, diagnosed as Diph-
theria without classification. These are shown in the analyses below
as unclassified Diphtheria. There were no recorded cases of Laryngeal
Diphtheria in the sample of Army Forms I.1220 coded.

North-West Europe, 1944-45
Admissions to Hospitals for Diphtheria
E.A.Rs. per 1,000 Strength and Relative Rates

Source: Hollerith Tabulations

1944 1945

1st

1. Equivalent Annual July-
Rates

Sept.

Faucial . # 0°04
Nasal i
Cutaneous —

Paralysis . 0°02
Gravis. Fane

Diphtheria
Unclassified 0-02
Totals 0-08

2. Relative Rates

Faucial 52°23
Nasal 1-21
Cutaneous 0-81
Paralysis . 4°05
Gravis. 0°40
Diphtheria

Unclassified . 59°46 | 42°68 | 39°29

Totals 100

With an E.A.R. of 1-29, Faucial Diphtheria was responsible for more
admissions than any other class. An initial rate of 0-04 was followed in
the second quarter by one of 0-79. This was succeeded by the peak rate
of 2-70 then 0-79, 0-50, and, finally, 1-18 per 1,000. There were com-
paratively few admissions for other types of Diphtheria. Unclassified
cases commenced at a rate of 0-02, reached 2-15 in the third quarter

THE ARMY MEDICAL SERVICES 211

and thereafter declined to a final rate of 0-59. Admissions for Faucial
Diphtheria were one-half the group total and those for unclassified
Diphtheria, forty-one per cent.

OTHER DISEASES

COMMON COLD recorded an annual rate of slightly under 3 per 1,000.
Admissions were lowest in the first quarter at o-g and highest in the
third and last quarters at 3-3 and 3-9 respectively. INFLUENZA registered
the highest rate at 0-27 in the third quarter. Rates varied but little
between o-11 and 0-27 per 1,000.

Admissions for SCABIES commenced with a low rate of 0-18 per 1,000
and closed at 1°6, with an E.A.R. of 1-4.

MALARIA recorded a rate of 1-19 in 1945. Apart from the first quarter
of the period under review, admissions ranged from 0-8 to 1:6 per
1,000. During the first quarter, however, an admission rate of 13-8 was
recorded. An analysis of these admissions indicates that most cases
occurred in August, one-eighth less in July and one-half the August
total in September. Admissions in June were only slightly less than
those in July. Comparative admissions were:

July . . 100
August 117
September. - 60

Those admitted were diagnosed Benign Tertian, Sub-Tertian or
Malaria (unspecified). No cases of Quartan Malaria were recorded in
this quarter, but one was admitted in June. Comparative admissions
were:

July August September
Benign Tertian . 39°40 66 -67 77°27
Sub-Tertian . : ; 0°54 0°35 _
Malaria (unspecified) : 60-06 32-98 22°73
100-00 100-00 100 -00

Diseases of the BLOOD and BLOOD-FORMING ORGANS caused admissions
at an average rate in 1945 of 1 per 1,000 and DYSENTERY at 0°86. The
latter, however, recorded the comparatively high rate of 4.3 in the
first quarter. Admissions for P.U.O. were 0-7, and RHEUMATIC FEVER
and MUMPS, 0°3 per 1,000. All other diseases produced admissions at
lower rates.

8cMs

212 CASUALTIES AND MEDICAL STATISTICS

INJURIES

Admissions to hospitals on account of injuries were classified, as
in other theatres, according to whether they were received in action
against the enemy (E.A. injuries) or otherwise (N.E.A. injuries). Many
Army Forms I.1220 on being received in the War Office were found to
be unclassified and are noted in the relevant tabulations in this section
as ‘Cause not known’.

As would be expected, the largest number of admissions for injuries
were recorded during the first quarter of the period when the rate was
132 per 1,000. This was followed by the comparatively low rate of 51.
In the third quarter it rose to 71 and then declined to 57 (fighting
ceased early in May). Rates thereafter were 22 per 1,000 for both
quarters.

Analyses of these injuries are presented in Tables 24 and 25. Of the
four periods under review during which active operations were in
progress, i.e. July 1944 to June 1945, admissions for injuries caused
through enemy action were greater than those not so caused, except in
the quarter April to June 1945. The former registered rates which began
at 97 per 1,000, fell to 26, increased to 43, and finally declined to 25.
Rates for N.E.A. injuries were comparatively constant. ranging from
23 to 29 per 1,000, being 26, 23, 26 and 29 respectively. The equivalent
annual rates were 48 per 1,000 for E.A. Injuries and 26 for N.E.A.
Injuries.

Comparative rates for these classes of injuries were:

E.A.R.

July-Sept.| Oct.—Dec.| Jan.—Mar.| Apr.—June|
Enemy Action .

‘: 78-60 53°10 62°42
Non-Enemy Action .

45°92 64°67
21°40 4690 37°58

54°08 35°33

100 100 100

Enemy Action

: 26
Non-Enemy Action .

100 26 44

Disregarding those injuries, the cause of which is not known, ad-
missions in the first quarter for those caused through Enemy Action
were nearly eighty per cent. of all injuries. This rate declined until,
in the last quarter, it was forty-six per cent. Injuries not due to Enemy
Action increased from twenty-one per cent. in the first quarter to
fifty-four per cent. in the quarter ended June 30, 1945. Enemy Action
Injuries accounted for sixty-five per cent. of the Equivalent Annual
Rate and N.E.A. Injuries some thirty-five per cent.

THE ARMY MEDICAL SERVICES 213

When admissions for the first quarter are taken as the base for com-
parison, those E.A. Injuries in the second and fourth quarters were one
quarter, and those in the third quarter under one half those in the initial
period. With N.E.A. Injuries, admissions in the second quarter were
eighty-five, in the third ninety-seven, and in the fourth quarter, one
hundred and ten per cent. of those in the first quarter. It must be
remembered, of course, that active warfare ceased in the early days of
May and that had fighting continued, admissions for E.A. Injuries might
well have equalled, or even surpassed, those in the previous quarter.

Enemy Action Injuries

Admissions for HEAD INJURIES at slightly under 4 per 1,000 in the
first quarter, were followed by rates of 1-6 in the second and fourth
and 2:8 in the third. In the last three quarters, admissions were equiva-
lent to between six and seven per cent. of the total for E.A. Injuries.
In the first quarter they were four per cent.

FRACTURES at sites other than the head were responsible for rates
which fluctuated between fourteen and four per 1,000. In spite of this,
expressed as a percentage of all E.A. admissions, the range was but one
per cent. from 14:23 to 15°42.

Admissions for BURNS varied little, from 0-8 in the first two quarters
to o-5 in the fourth. They were, in the first quarter, less than one per
cent. of all E.A. Injuries, three per cent. in the second quarter and, in
the third and fourth quarters, somewhat less than two per cent.

OLD INJURIES caused admission rates which varied little during the
year. The range was from 0-11 to 0-16. In the last two quarters of 1945,
however, admissions increased to 0-4 per 1,000.

Non-Enemy Action Injuries

Admissions for HEAD INJURIES ranged from 1 to 2°5 per 1,000, and
increased and declined in alternate quarters. The lowest rate occurred
in the first quarter and the highest in the second and sixth. They were
equivalent to from four to thirteen per cent. of all N.E.A. Injuries.

FRACTURES at sites other than the head produced rates highest in the
fourth quarter at 10 per 1,000 and lowest in the following quarter at 7.
Expressed as percentages of all N.E.A. Injuries, admissions for Fractures
ranged from thirty-three in the second quarter to thirty-eight per cent.
in the last. :

Admissions for BURNS increased from 2 per 1,000 in the first quarter
to 3 in the third. In the fourth period the rate was 2-6, following which
it declined to o-g and o-5 in the final quarters. They were equivalent,
in the first four quarters, to between seven and eleven per cent. of all
admissions for N.E.A. Injuries.

OLD INJURIES accounted for rates which were slightly higher than those
caused by Enemy Action. Rates ranged from 0-22 to 0-49 per 1,000.

214 CASUALTIES AND MEDICAL STATISTICS

Injuries—Cause not known

These were between five and ten per cent. of all admissions for
injuries, at rates commencing at 8 and declining to slightly over 2 per
1,000. They contained a comparatively large percentage of admissions
for Burns and for Old Injuries.

If these injuries are proportionately allocated to E.A. and N.E.A.
Injuries according to the numbers admitted for those classes, the
results are as below.

All Injuries
North-West Europe, 1944-45
Admissions to Hospitals for Injuries
(Adjustment of Tables 24 and 25)
Equivalent Annual Rates per 1,000 Strength and Relative Rates

Source: Hollerith Tabulations

1944 1945

July- | Oct.-
Sept. | Dec.

Apr.-
1, Equivalent Annual Rates

Enemy Action:
Head Injuries.
Fractures (Omer Sites)
Burns

Old Injuries * . ‘ 0°48 | 0°43
Other Injuries - 0°24 | 0°07
Totals . ‘ . 0:78 | 0-50
Non-Enemy Action:
Head Injuries. i 1°57 | 2°69
Fractures (Other: Sites) . 8-15 9°09
Burns A . S 0:96 | 0:58
Old Injuries 0°30 | 0°45
Other Injuries 10°55 | 8-59
Totals 31°05 | 21°53 | 21°40
2. Relative Rates
Enemy Action:
Head Injuries.
Fractures (Osher; Sites)

Burns 5
Old Injuries
Other Injuries .

Totals . : e

Non-Enemy Action:
Head Injuries
Fractures (Opes Sites)
Burns
Old Injuries S .
Other Injuries - Es

Totals

THE ARMY MEDICAL SERVICES 215

Based on the above, Equivalent Annual Rates for the year ended
June 30, 1945 (by which date active operations had ceased), are pre-
sented below.

North-West Europe, 1944-45
Admissions to Hospitals for Injuries for the year ended June 30, 1945
Equivalent Annual Rates per 1,000 Strength and Relative Rates

Source: Hollerith Tabulations

Non-Enemy All

Enemy Action
Action Injuries Injuries

Injuries

juiva-|

lent lent | Rela-
Annual Annual|_ tive

Rates Rates | Rates

Head Injuries é 4 e 2°64 1°88 | 6-86
Fractures (Other Sites) . 2 7°30 9°59 | 34°97
Burns . ; 3 “ * 0°72 2°63 9°59
Old Injuries 7 . or13 0°35 1°28
Other Injuries . ‘ . | 39°52 12°97 | 47°30

Totals . < ‘: . | 50°31 27°42 |100

Admissions for all injuries recorded a rate of 78 per 1,000. Of these,
two-thirds were sustained in action. One in every five injuries was a
fracture, other than of the head. Admissions for Head Injuries were
approximately one-third of those for fractures and slightly more than
one-half were sustained in action. Casualties for Burns were higher
among N.E.A. Injuries, being nearly four times the E.A. rate. Admissions
for N.E.A. Old Injuries, although comparatively small, were nearly
three times those of the other class.

ADMISSIONS TO ALL MEDICAL UNITS

Table 27 records admissions to all medical units for certain diseases.
These statistics were obtained from monthly Hygiene reports, but
only those from May to December 1945 are available. Mean Monthly
Rates (M.M.Rs.) are given in the tabulation, together with an Equivalent
Annual Rate for that year. Rates are based on 100,000 strength instead
of the conventional 1,000 in order that the graduations of admissions,
especially in respect of some rarer diseases, may be appreciated. As
an example, M.M.Rs. of admissions for Cerebro-Spinal Fever are given
in the table as 1-14, 1°06, 0-26, 0°54, 0:28, 0-28 and 0-34. Had they
been calculated per 1,000 strength, rates would have been shown as
0°01, 0°01, 0:00, 0:01, 0-00, 0-00 and 0-00.

At first sight, it may be considered that the rates in this table should
be greater than, or at least equivalent to those in Table 23, which

216 CASUALTIES AND MEDICAL STATISTICS

records admissions to hospitals only. In point of fact, however, some
rates are lower. This may be due to either or both of the following
reasons:

(a) The statistics in Table 23 were built from a ten per cent. sample
of A.F. I.1220, the sample comprising cards on which the Army
number of the patient ended in the digit 5. It may be that, in
the rarer disease, such cards may have been more frequent than
the average warranted.

(b) Table 27 represents information for only the last eight months of
1945. Equivalent Annual Rates based on those months would
necessarily be low if admissions during the period January to
April were higher than the average. This is exemplified in
Diphtheria and Jaundice for which admission rates in the quarter
January to March 1945 were higher than those of the three
ensuing quarters.

VENEREAL DISEASES

Of the diseases enumerated in Table 27, admissions for Venereal
Diseases were by far the more numerous, with an Equivalent Annual
Rate of 9,139 per 100,000 (91°39 per 1,000). Admissions rose from 280
in May to a peak of 1,010 in August, subsiding to 820 in December.
An analysis of admissions for this group are given below.

URETHRITIS was responsible for eighty-five per cent. of the group
admissions at monthly rates which ranged from 230 per 100,000 in
May to a peak of 875 in August. Subsequently, a decline occurred and
the rate fell to 655. The Equivalent Annual Rate was 7,721 per 100,000

North-West Europe, 1945
Admissions to all Medical Units for Venereal Diseases
Mean Monthly, Annual, Relative and Comparative Rates

Source: Hygiene Reports. Rates per 100,000 Strength
1. Mean Monthly! Mean Monthly Rates, 1945 ele
and Annual Rates|"yaay_| June | July | Aug. | Sept. | Oct Dec. | “Rates
Syp!
(a) tly 2 23°47 | 30°70} 52°56 | 91-01 | 97°03 | 88-93 100°16 871:29
b) pate a 0°27 2:38 0-9 org o-75 0°30 1°62 10-2
rethritis

(a) Smear positive
$53°34 | 5,876-02

80-13 | 1,407°51
22-20 4a7'¢
16-67

for . - | 140-68 | 266-37 | 534°77 | 630-79 | 642-88 | 582-84
(b) Smear negative
for Ge . i 72-81 | 1o1-so | 156-72 | 175:06 | 141-13 | 114°68

16-67 21°87 61°72 69°57 | 37°23 36-98

(© Smear not
reported
Chancroid . . 0°67 0°56 rear 1°42 1°20 2:25

61-90 | 519°89
821-88 | 9,139°11

Diseases . =. | 24°54 | 21's9 | 46°60 | 43°30 | 40°37 | 56-44
Totals . « | 2797311 | 444°97 | 854-17 |1,011-29] 960-59 | 882-42

838-31

THE ARMY MEDICAL SERVICES 217

2. Relative Rates

(a) Early . . 8-41 6-90 10:08 | r3°s" 12°19 o
5) Late. Py o-10 0°54 0°03 o og o
rethritis
(a) fee Positive | 50°40 | 59°86 66-05 | 67°48 | 67°33 64:3
forGe . .
(b) Smear negative
for Ge . . 26-09 | 22°81 1300 | 11°49 9°75 15°40
(c) Smear not
reported : S97] 4°91 4:19] 3:03] 2°70 4:7
Chancroid . * 0°24 0°13 0-325 0-16 O-31 on
Other Venerea
Diseases 8-79 4°85 6-40 6°19 7°53 5°69
Totals . « | 100 100 100 100 100 100
3. Comparative Rates (May = 100)
Syphilis |
(a) Early . « | 100 1 3 2: 388 41 379 4. ph
2, Late. + | 100 881 2s 52 a7 Wr as
rethritis
(a) Smear positive
forGe . |. | 100 189 380 448 457 4l4 402 393
(b) Smear negative
for Ge . + | 100 139 215 240 194 158 132 110
(c) Smear not
reported . | 100 131 370 417 2a3 222 152 13
Chancroid . . | 100 % 166 212 179 336 204 373
Other Venereal
Diseases * 100 88 190 176 165 230 aur 252
Totals . « | 100 159 306 362 344 316 300 294

(77 per 1,000). Throughout the eight months, the percentage of Ureth-
ritis to all admissions in the group was fairly constant, with a range of
80 to 88. Positive smears were four times negative smears and those
unreported as either positive or negative were some five per cent. of all
cases.

SYPHILIS recorded an E.A.R. of 880 per 100,000 (8-8 per 1,000).
This was slightly less than ten per cent. of all admissions for the group.
The trend of these admissions was somewhat different to that of Ureth-
ritis, the rates for which increased until August and then declined.
Admissions for Syphilis, however, except for a slight decrease in October,
consistently recorded increases each month from 23 in May to 100 in
December.

The rate for CHANCROID was comparatively low at 17 per 100,000
with a monthly range of 0-56 to 2°53 and a trend similar to that for
Syphilis. Admissions for Other Venereal Diseases with an annual rate
of 520 per 100,000 ranged from 22 to 62.

SCABIES

Next in order of numerical importance were admissions for Scabies.
Here, rates are available for eleven months. The equivalent annual

218 CASUALTIES AND MEDICAL STATISTICS

rate was 6,927 per 100,000 (69 per 1,000). Admissions in February at a
rate of 360 increased to 400 in March, then declined to 280 in June.
From July, which recorded a rate of 320, increases were registered each
month until a rate of 1,200 was reached in November. This was followed
by a slight decrease to 1,080 in December.

Mean Monthly rates, with Relative and Comparative Rates are given
below.

North-West Europe, 1945

Admissions to All Medical Units for Scabies
Mean Monthly, Relative and Comparative Rates

Source: Hygiene Reports. M.M.Rs. per 100,000 Strength

Admissions were highest in the last four months of the year when
they were two to three times those in February, and comprised over
sixty per cent. of the total for the eleven months. The highest monthly
rate of 1,199 per 100,000 occurred in November. This was slightly
under twenty per cent. of all admissions, over three times the rate for
February, and over four times the lowest rate. Admissions were lowest
in June, when admissions were four per cent. of the total and eighty
per cent. of those in February.

DYSENTERY

The equivalent annual rate for this disease was 2,068 per 100,000
(21 per 1,000). Mean Monthly rates ranged from 290 to 160 during the
period May to September and from 84 to 71 during October to Decem-
ber. An analysis of these admissions follows on page 219.

The admission rate in May was 260 per 100,000 (2:6 per 1,000). In
June it fell to 187 then increased to 294 before declining to 248 in
August. It decreased by one-third during September to 159. A sharp
decline to 84 in October was followed by rates of 71 and 77 in the two
following months.

THE ARMY MEDICAL SERVICES 219

North-West Europe, 1945
Admissions to All Medical Units for Dysentery
Mean Monthly, Equivalent Annual and Comparative Rates

Source: Hygiene Reports. M.M.Rs. and E.A.Rs. per 100,000 Strength
1. Relative Rates| May June July Aug. Sept. Oct. Nov. E.AR.
tery:
ozoal
(Confirmed) is 0-25 - 0°53 0°40 0-28 emg _ oz 4a
ys 1-77 o +36 | 10-6: um 2:27 pare 1-0 43°86
oS mes 93} 7:3 3] 4 4 3
Gastro-Enteritis) | 258-12 | 186-17 | 285-62 | 236-49 | 154-16 80-47 69°62 | 75°86 |2,019°76
Totals . + | 260-14 | 187-10 | 293-51 | 247-52 | 158-55 | 83-87 | 70°76 | 77°06 | 2,067°76
2. Comparative Rates

Protozoal + | 100 ce sf
Bacillary . =. | 100 4 s!
Clinical ID | 100 27 29

Totals .

CLINICAL Dysentery (which included Gastro-Enteritis) was respon-
sible for nearly ninety-eight per cent. of all Dysentery cases. These
naturally followed the total admission trend of the group. Admissions
for BACILLARY Dysentery, which were some two per cent. of all cases
in the group, ranged from 0-93 in June to a peak of 10-63 in August.
There were very few cases of confirmed PROTOZOAL Dysentery, those
recorded being only one-fifth per cent. of all Dysentery cases.

JAUNDICE

The Equivalent Annual Rate of admissions for Jaundice in 1945 was
614 per 100,000 strength (6-14 per 1,000). Admissions, rates of which
ranged from 41 in July to a peak of 67 in November are analysed below.

North-West Europe, 1945

Admissions to All Medical Units for Jaundice
Mean Monthly, Equivalent Annual and Comparative Rates

Source: Hygiene Reports. M.M.Rs. and E.A.Rs. per 100,000 Strength
1. Infective Hepatitis, 1945 Mean Monthly Comparative
Rates Rates
May + 2 ‘ * e 45°11 100
June _ fe a ‘ . 46°61 103
July 5 i 4 f 40°60 go
August . ‘ Z ‘ ; 43°45 96
September ; é ‘ 2 87°24 127
October . is é = 2 02°76 139
November Ry 3 E : 66-84 148
December i a A 2 45°72 101
Equivalent Annual Rate per 100,000 612°49

2. Post-Arsphenamine

1 admission in May, 2 in July and 2 in October.
3. Leptospirosis

1 admission in October.

8*cms

220 CASUALTIES AND MEDICAL STATISTICS

Admissions on account of POST-ARSPHENAMINE and LEPTOSPIROSIS
were extremely few. Those for INFECTIVE HEPATITIS varied only slightly
during the period May to August with rates which ranged from 41 to
46 per 100,000. In September, admissions increased to 57. This was
followed by further increases to 63 and 67, but by December the rate
declined to 46, only slightly above the rate in May.

DIPHTHERIA

Statistics relating to Diphtheria are available in respect of Faucial
and Cutaneous. There were very few admissions for the latter cause;
indeed they were less than two per cent. of the total. Monthly rates are
given below.

North-West Europe, 1945
Admissions to All Medical Units for Diphtheria
Mean Monthly, Equivalent Annual and Comparative Rates

Source: Hygiene Reports. M.M.Rs. and E.A.Rs. per 100,000 Strength

1. Mean Monthly}
and Equivalent

Annual Rates Aug. # i 5 E.A.R.
Diphtheria:

Cutaneous. ped ree) 3B 75°38

Totals . < . . Ir-04 rte 182-61

2. Comparative Rates

Diphtheria .

00 61 | 59

Rates of admissions declined by over fifty per cent. from 19 per
100,000 in May to 8 in August. A rate of 16 in September increased to
23 in November and ended at 19, very slightly above the rate in May.
The Equivalent Annual Rate was 183 per 100,000 (1-8 per 1,000).

MALARIA

Statistics in the Hygiene Reports for admissions on account of
MALARIA were broken down to three components, Benign Tertian,
Malignant Tertian and Clinical and Other Types. They were further
split as to whether or not the Malaria was Indigenous. Analyses are
given below.

Malaria recorded an Equivalent Annual Rate of 111 per 100,000
(1-11 per 1,000) in 1945. Monthly rates varied little during the period
May to August and were in the range of 11 to 14. Rates during the
last four months also showed little variation but were lower at from

5 to7.

Non-Indij u
B.T. nn
M.T. ef
Clinical and

Others

‘Total Non-
Indigenous

‘Total Malaria

THE ARMY MEDICAL SERVICES 221

North-West Europe, 1945
Admissions to All Medical Units for Malaria
Mean Monthly, Equivalent Annual and Comparative Rates

M.M.Rs. and E.A.Rs. per 100,000 Strength

e rts.

=. 3°77 4°66 8-92 12°25 | 10-00
rig - 1°83 8-ar 3°27
1g 3°77 6°49 20°46 | 13°27
66-61 *a3 | 43°s1 28-53 | 40°00
ry] — 0-92 = pus
gUeir 50°00 49°08 5I°Or 46°73
98°86 | 96°23 | 93°s1 79°34] 86-73
100 100 100 100 100 100 100

3. Comparative Rates

Over the whole period, admissions on account of INDIGENOUS
Malaria were one-eighth of the total of the group, but monthly percen-
tages varied considerably from one in May to thirty in September and
December. Rates increased from 0°13 per 100,000 in May to 2-4 in
September, declined to 0-65 in November and ended with a rise to
2-06 in December. The Equivalent Annual Rate was 13-6. There were
no recorded admissions for Malignant Tertian Malaria. Admissions
for Benign Tertian Malaria were double those for Clinical and Other
Types and ranged from 0-4 in June to 1-7 in September. There were
no cases in May. Rates for Clinical Malaria ranged from 0-13 in May
to 1-20 in December. No admissions were reported during June or

August.

222 CASUALTIES AND MEDICAL STATISTICS

Admissions for NON-INDIGENOUS Malaria commenced at 11 in May,
increased to 13 in July and steadily declined to 4 in December. The
Equivalent Annual Rate was 97. Cases of Benign Tertian Malaria,
which recorded an E.A.R. of 48, decreased from 7-6 in May to 2 in
December. Rates for Clinical Malaria increased from 3-5 in May to
7 in July before declining eventually to 2:2 in December. Equivalent
Annual Rates for Benign Tertian and Clinical admissions were almost
equal at 47:8 and 48-3 respectively and were each approximately forty-
three per cent. of all admissions for Malaria. There were very few cases
of the Malignant Tertian type, and then only in May, July and August.

Compared with those in May, admissions for all Benign Tertian
Malaria fell by thirty per cent. in June before increasing to ninety per
cent. in July. Following this, there was a decline, until by December
they were under forty per cent. of the May admissions. Rates for Clinical
Malaria increased to slightly under double that in May, then decreased
to under seventy per cent. in November. Admissions in December were
ninety per cent. of those in May.

PNEUMONIA

Monthly rates of admissions for Pneumonia declined from 6 in May
to 3 in September and October and increased to 8 in December. The
Equivalent Annual Rate was 52 per 100,000 (05 per 1,000). These
admissions are analysed below.

North-West Europe, 1945
Admissions to All Medical Units for Pneumonia
Mean Monthly, Equivalent Annual, Relative and ComparativeRates

Source: Hygiene Reports. M.M.Rs. and E.A.Rs. per 100,000 Strength
1. M.M.Rs. and
E.A.Rs. Nov. | Dec. | E.AR
Pneumonia.
Lobar 2°94 7:02 32°19

Ones Goctuding
Influenzal)

Totals .

2. Relative Rates

THE ARMY MEDICAL SERVICES 223

LOBAR Pneumonia accounted for nearly two-thirds the total admissions
for the group. Rates declined from 3 per 100,000 (-03 per 1,000) in
May to 1 in July and then increased monthly to 3 in November. During
the following month, admissions more than doubled to 7. The highest
rate of admissions in respect of virus Pneumonia occurred in May at
24 and the lowest in October at 0.14. In December (when the highest
rate for Lobar Pneumonia was recorded), the rate was 0-68, slightly
above one-half the average rate of admission for the period. OTHER
TYPES produced rates which increased and decreased in alternate
months. The range exhibited was from 0-4 to 1-05. These rates occurred
in August and July respectively. The Equivalent Annual Rate of 8 per
100,000 was some fifteen per cent. of the total admissions for the group.

TUBERCULOSIS

Admissions for Tuberculosis varied but little during the eight months
under review. The range of rates was from slightly under 3 in the first
four months to 4 in September. The Equivalent Annual Rate was 39
Per 100,000 (0-39 per 1,000). The majority of cases were of the PUL-
MONARY type. OTHERS were six per cent. of the total. An analysis of these
admissions are given below.

North-West Europe, 1945
Admissions to All Medical Units for Tuberculosis
Mean Monthly, Equivalent Annual and Comparative Rates

Source: Hygiene Reports. M.M.Rs, and E.A.Rs. per 100,000 Strength
1. M.M.Rs. and
E.A.Rs. May June July Aug. | Sept. Oct. Nov. Dec. | E.A.R.
Tuberculosis:
Pulmonary Py 2°40 2:26 2-76 2°56 aur 3°68 3°60 3°25 36°93
Other types: ri Coty 0°53 o-13 0-13 — O-14 — O17 2°42
Totals . : 2-91 2-79 2°89 2°69 aur 3°82 360 3:42 39°35

2. Comparative Rates

‘Tuberculosis:
Pulmonary + | 100 04 115 107 171 153 150 135
Other types . | 100 104 25 25 _- 27 om, 33
Totals . . | 100 6 9 | 92 Jr 131 124 118

SCARLET FEVER, MEASLES, MUMPS, CHICKEN POX AND RUBELLA

Equivalent Annual Rates for these diseases ranged from 7 per
100,000 in the case of Rubella to 20 for Scarlet Fever. Admissions are
analysed below.

224 CASUALTIES AND MEDICAL STATISTICS

North-West Europe, 1945
Admissions to All Medical Units for
Scarlet Fever, Measles, Mumps, Chicken Pox and Rubella
Mean Monthly, Equivalent Annual and Comparative Rates

Source: Hygiene Reports. M.M.Rs. and E.A.Rs. per 100,000 Strength

1. M.M.Rs. and

E.A.Rs. May June July Aug. Sept. Oct. Nov. Dec. E.AR.

Scarlet Fever 2°65 a3 arto 1°48 0°99 1°42 1-31 1°88 19°93
jeasles 3°54 ° 1-0 0°40 0°57 or 0°49 3°08 Ig-tr

Mumps 2°53 1°20 mn 0°27 itz 1 28 ro 0°68 14°61

Chicken Pox rig 0-80 0-92 0°94 0°57 ° E 0°65 2°91 12°96
‘ubella. B72. 1°06 or13 0°S4 0°43 0-85 - _ T17

Apart from Chicken Pox, the highest rates of admission occurred in
May. Most admissions on account of CHICKEN POX were in December,
when the rate was two-and-a-half times that for May. During the period
June to November, admissions for MEASLES were less than one-third
those in May, but in December rose to nearly ninety per cent. There
were no recorded cases of RUBELLA in November or December. The
Equivalent Annual Rate for Measles at 15 was three-quarters of that for
Scarlet Fever. The rate for Mumps was slightly less at 14, Chicken pox
was 13 and Rubella 7.

ENTERIC GROUP OF FEVERS

This group was responsible for admissions at an Equivalent Annual
Rate of 8 per 100,000 (0-08 per 1,000) analysed as under.

North-West Europe, 1945
Admissions to All Medical Units for Enteric Group of Fevers
Mean Monthly, Equivalent Annual, Relative and Comparative Rates

Source: Hygiene Reports. M.M.Rs. and E.A.Rs. per 100,000 Strength
1. M.M.Rs. and
E.A.Rs. Oct Nov. Dec. | E.A.R.
Enteric Group of
Fevers
hoid 0-28 0-16 o-17 4ri3
Paratyphoid oa] — = 1°43
Clinical
Others . 0°43 - = 2°46
Totals 0-99 0°16 om7 8-02

THE ARMY MEDICAL SERVICES 225

2. Relative Rates
i . | 67 25 40 86 38 28 100 100 st
Paratyphoid . : r 20 14 2. - - 18
Clinical and Others 33 50 4° _- 3 “” - - 31
Totals . + | 100 100 100 100 100 100 100 100 100

Admission rates commenced in May at 0-76, declined to 0-53 in
June, rose to 1°14 in September and fell to 0:16 in November and
December. TYPHOID accounted for one half, and PARATYPHOID less than
twenty per cent. of all admissions for this group. There were no cases
of Paratyphoid in May, November or December.

OTHER DISEASES

(a) CEREBRO-SPINAL FEVER, with an Equivalent Annual Rate of 5:9
per 100,000.

(b) PoLiomyeELitis, which recorded rates (apart from September when
there were no admissions) in the range 0-17 (December) to 0-67
(August), with an E.A.R. of 4 per 100.000.

(c) TYPHUS FEVER, with admissions in May, June and August only.
The E.A.R. was 1-01 per 100,000.

(d) ENCEPHALITIS, which registered low rates of admission in May
and September only.

226 CASUALTIES AND MEDICAL STATISTICS

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227

THE ARMY MEDICAL SERVICES

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228 CASUALTIES AND MEDICAL STATISTICS

TABLE 24

North-West Europe, 1944-45
Admissions to Hospitals through Injury
Equivalent Annual Rates per 1,000 Strength

Source: Hollerith Tabulations

1. Enemy Action
Head Injuries.
Fractures (Other Sites)
Burns ;
Old Injuries. %
Other Injuries .

Totals

2. Non-Enemy Action
Head Injuries.
Fractures (Other Sites)
Burns
Old Injuries
Other Injuries

Totals

1°58 _- _
3°83 | 0°05 _
0-47] — =
orn | 0°44] 0°39
18-85 | 0-22 | 0:06

2°26 | 1°42] 2°40
10°13 7°36 | 8:11
2°57 | 0°87 | 0-52
0°37 | 0°27 | 0°39
13°91 | 9°54 | 7°66

3. Cause Not Known
Head Injuries .
Fractures Cia! Sites)
Burns z
Old Injuries.
Other Injuries .

Totals

Total admissions sree
Injuries . é

Percentage of admissions for all
Causes . 6

57°41 | 22°31

a8

THE ARMY MEDICAL SERVICES 229

TABLE 25

North-West Europe, 1944-45
Admissions to Hospitals through Injury
Relative Rates

Source: Hollerith Tabulations

. Enemy Action
Head Injuries.

Fractures (Other Sites)
Burns :
Old Injuries 2 2
Other Injuries . 5

Totals . .

2. Non-Enemy Action
Head Injuries.
Fractures (Other Sites)
Burns :

Totals . ‘ J
3. Cause Not Known
Head Injuries .
Fractures (Other Sites)
Burns

Old Injuries Ps ;
Injuries . * :

Totals . 3 . .

230 CASUALTIES AND MEDICAL STATISTICS

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231

THE ARMY MEDICAL SERVICES

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CHAPTER IV

BRITISH NORTH AFRICAN
and
CENTRAL MEDITERRANEAN FORCES

TATISTICS FOR the British North African and Central Mediterranean
& ‘orces which appear in this section have been obtained from weekly

reports of admissions to medical units, rendered through Districts to,
and consolidated at, Medical Branch, General Headquarters. This is at
variance with most other Commands where medical units compiled
statistical returns, sometimes on a modified form of A.F. A.31, at
monthly intervals, for submission to G.H.Q. The return used by
B.N.A. and C.M.F. was peculiar to, and appears to have been devised
for use solely within, that Command. Diseases individually reported
differ somewhat from those reported in a comparable Command, i.e.,
Middle East Forces. The latter reported admissions for such diseases
as Mumps, P.U.O., Effects of Heat, Measles, etc., whereas B.N.A. and
C.M.F. did not. Similarly, admissions for Dermatophytosis, Pediculosis,
Gas Gangrene, etc., appear in the returns for B.N.A. and C.M.F., but
not in those for M.E.F. On the other hand, admissions for Dysentery,
Enteric Fever, Jaundice and Malaria, which were common to returns
in both Commands were broken down in the B.N.A. and C.M.F.
returns. Indeed, Malaria was broken down not only to B.T., M.T. and
Q., but also, under these headings, to Primary and Relapse. Incidentally,
it is interesting to note that only in this Command was Malaria broken
down to Primary and Relapse.

From the landings until mid-1945, only one significant change was
made in the nature of the return. Until November 1943, medical
statistics for all classes of Troops were reported under the blanket
heading of ‘All Troops’, no distinction being made as to the ethnic
composition of the Forces. From that month, however, admissions were
listed under the different national entities. It was possible, therefore,
from January 1944 to prepare separate morbidity tabulations for
British, Canadian, New Zealand, Indian and African Troops as well as
for ‘All Troops’.

In mid-1945, this policy was changed. Instead of the weekly return of
admissions to Medical Units being rendered, a monthly return was
introduced. In the new return, the number of diseases to be reported
was doubled, more information was required and the number of sheets
in the return was increased from one to a minimum of six. The return
became cumbersome. As an instance of the greater detail required, the
weekly return required Venereal Disease to be broken down under five

232

THE ARMY MEDICAL SERVICES 233

headings, Gonorrhoea, Syphilis, Chancroid, Lympho-granuloma and
‘Other Forms’, but the monthly return required figures under the head-
ings Syphilis early, Syphilis late, Urethritis smear +ve GC, Urethritis
smear—ve GC, Urethritis not tested, a similar three headings for
Vaginitis or Cervicitis, Lympho-granuloma and Chancroid. Again, the
weekly report required figures for Diphtheria, but the monthly return
required this to be split under the headings Faucial, Laryngeal and
Nasal, Cutaneous and Polyneuritis. In all, the new return contained
over 100 items against 59 in the old.

At the same time, a regrouping of nationalities was made for statistical
purposes. Where, during the previous eighteen months it had been
possible to produce statistics separately for Canadian and New Zealand
Troops, these were now bulked together under the heading ‘Dominion
Troops’. Again, African Troops were now placed under the heading of
‘Colonial Troops’, which included such diverse ethnic groups as
Seychellois, Maltese, Cypriots, etc. The net result is that for 1945
figures can be given only for the first six months in respect of Canadian,
New Zealand and African Troops.

The basic medical statistics required from a force overseas can be
grouped under three headings:

(1) Admissions, by diagnoses, to medical units.

(2) Death, by causes, occurring in medical units.

(3) Invalids, by diagnoses, transferred to the United Kingdom or

country of origin.

Although the returns reviewed above met the requirements of (1)
they are lacking in detail regarding deaths and invalids. The only
information available from the returns regarding deaths in medical
units is the total number occurring from disease. Although this data is
desirable, it is still more desirable to know the causes of such deaths,
also the statistics relating to deaths from injuries, through Enemy
Action and other causes. It is not possible, therefore, as in some other
Commands, to prepare mortality tabulations for B.N.A. and C.M.F.
The information obtainable from the returns with regard to invalids is
even less than that for deaths. The only data available is the number of
invalids recommended for transfer. What is required, here, is the
number, by diagnoses, of invalids actually transferred to the United
Kingdom (or other country) during each accounting period. Here again,
it is impossible to prepare invaliding statistics for the Command.

Up to mid-1945, the returns were submitted weekly. These have
been converted to a monthly basis, and mean monthly rates (M.M.R.)
per 1,000 strength have been computed. In consolidating from the
weekly returns, some months will contain 4 weeks (28 days) and others
5 weeks (35 days). Such figures have been adjusted to a month of fixed

234 CASUALTIES AND MEDICAL STATISTICS

length, 30-5 days, almost exactly one twelfth of a calendar year. The
annual rates were obtained by a summation of the twelve mean monthly
rates.

The Force began landings in North West Africa on November 8,
1942 and reasonably accurate figures for admissions to Medical Units
were available from early 1943. The tabulations which follow, therefore,
commence from January 1, 1943 and those available before that date
have been ignored as unreliable. As in most other sections, rates are
shown per 1,000 strength. In some cases, mainly in 1943, weekly
returns, although listing admissions, omit some District strengths.
In such cases, admissions figures have been ignored. District strengths
fluctuated so violently in 1943, that it was felt safer to ignore the avail-
able admission figures, rather than to attempt to ‘average out’ the rates.
For this reason, the figures do not include all known admissions and
any discrepancy in statistics between this and other volumes is thus
partly explained. Apart from this, the tabulations here presented include
all information reported on the returns relating to admissions.

With one exception, the figures given in this section relate to admis-
sions to all medical units, be they General Hospitals, Casualty Clearing
Stations, Field Ambulances, or other type of unit. Care had been
taken administratively, to ensure that there were no ‘double admissions’,
ie. transfers between units being shown as admissions to both units.
The inviolable rule was that cases diagnosed for the first time only were
shown as admissions, irrespective of the fact that they might have been
transferred, undiagnosed, from another unit. The exception referred
to above was the figures for scabies. Here, all cases were reported,
whether admitted to medical units or whether treatment was given in a
unit medical centre or elsewhere.

Tables 28, 30 and 32 exhibit the causes of admission for All Troops
during 1943, 1944 and 1945 with Tables 29, 31 and 33 showing the
breakdown of certain diseases and disease groups for those years.

Diseases which displayed a striking seasonal swing had peak incidence
during the periods noted:

Diphtheria ........... November—January
Dysentery..........4+ June—October
Infective Hepatitis ....September—January

Malaria ............ July—October (1943)
March—August (1944)

Pediculosis .......... December—March
Sandfly Fever ........ July—October

THE ARMY MEDICAL SERVICES 235

The incidence of the ENTERIC GROUP of Fevers did not show any
particular trend in 1943, but in the following year admissions increased
sharply from June to September.

Admissions for diseases as below, decreased in 1944 a8 compared
with 1943.

from 19-9 to 9:0 per 1,000
from 29-1 to 11°5 per 1,000
from 82-9 to 66-0 per 1,000
from 48-9 to 16-3 per 1,000
from 28-4 to 17°1 per 1,000

System veces ceive aloes oi from 113-6 to 74:2 per 1,000

Diseases showing large increases in 1944 as compared with 1943
were:

Psychoneuroses.............- from 8-5 to 21°5 per 1,000

Venereal Diseases. from 26-9 to 50-6 per 1,000

(The E.A.R. for 1945 was 63-7)

PRIMARY MALARIA showed a striking decrease of over fifty per cent.
from 77:7 in 1943 to 353 per 1,000 in 1944. MALARIA RELAPSE, however,
as might be expected, increased sharply from 5-3 in 1943 to 30-8 in
1944. Relapse occurred chiefly during the period March to June 1944,
when the mean monthly rates were well over 3 per 1,000.

The annual morbidity rates do not vary greatly, being 564 in 1943,
552 in 1944 with an E.A.R. of 468 for 1945. MALARIA and VENEREAL
DISEASES together accounted for one fifth of the total admissions for
diseases in both 1943 and 1944. SCABIES, PEDICULOSIS, I.A.T. and
DERMATOPHYTOSIS together accounted for a further quarter in 1943 and
one seventh in 1944, while admissions for INFECTIVE HEPATITIS,
PSYCHIATRIC DISORDERS and DYSENTERY together were one-eighth of the
total in both years.

Tables 34 to 53 show the causes of admission to medical units during
1944, and, for the first six months of 1945 (with an equivalent annual
rate) separately for Canadian, New Zealand, Indian and African
Troops. Table 44 shows the causes of admission for British Troops for
the whole of 1945. These tables indicate:

(a) a low rate for DIPHTHERIA among Indians and Africans.

(b) an extremely high rate for INFLUENZA among Canadians in 1944
(10-8 per 1,000 as compared with 3-5 for the next highest class of
troops and an All Troops rate of 2:2).

(c) Canadian and New Zealand Troops were more prone to INFEC-
TIVE HEPATITIS.

236 CASUALTIES AND MEDICAL STATISTICS

(d) Indian and African Troops were more prone to TUBERCULOSIS.

(e) there was very little difference in the rates for DYSENTERY
between British and Indian Troops. This is contrary to the
conclusion reached in the chapter dealing with the Army in
India where the rates for British Other Ranks were from two to
four times those for Indian Other Ranks.

(f) a comparatively low incidence for MALARIA among New Zealand,
Indian and African Troops.

(g) British Troops were more prone to SANDFLY FEVER than were the
other classes of troops.

(h) the rates for scABIES were lowest among Indian and African
Troops.

(i) Canadian Troops had the highest incidence of VENEREAL DISEASES
in 1944, followed by Africans, British and New Zealanders, with
Indians less than one third of the Canadian rate.

(j) PSYCHIATRIC DISORDERS were highest among Africans with
Canadians a close second. Indians had the lowest rate, one
quarter that of Africans.

(k) British Troops had a much higher incidence of PEDICULOSIS and
SCABIES than any other class of Troops.

No attempt has been made to compare the 1918 admissions for
certain diseases in Italy with the tabulations presented here. The
Medical Statistics volume of the ‘Official History of the Medical Services
in the Great War’ tabulates only four diseases, Dysentery, Malaria,
Pneumonia and Venereal Diseases for all British Troops in Italy in
1918, although more detailed figures are available for such troops in the
forward areas. As the data herein recorded included British Troops
serving in areas other than Italy, a comparison with the 1918 records
is not valid.

THE ARMY MEDICAL SERVICES 237

TABLE 28
British North African and Central Mediterranean Forces. All Troops. Causes of Admission to Medical Units, 1943

Mean Monthly and Annual Rates per 1,000 Strength

itis Meni
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jitis—t

eases

Meni
Meni:
Pedic

Source: B.N.A.F. and C.M.F. Weekly Health States
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238 CASUALTIES AND MEDICAL STATISTICS

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248 CASUALTIES AND MEDICAL STATISTICS

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256 CASUALTIES AND MEDICAL STATISTICS

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262 CASUALTIES AND MEDICAL STATISTICS

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264 CASUALTIES AND MEDICAL STATISTICS

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266 CASUALTIES AND MEDICAL STATISTICS

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8” riav.L

268 CASUALTIES AND MEDICAL STATISTICS

| “am + wore Oo onto ye ere of gues v

Troops. Causes of Admission to Medical Units, 1945

Breakdown of Certain Diseases Shown in Table 48. Mean Monthly Rates (Jan. to June) and Equivalent Annual Rates per 1,000 Strength

TABLE 49
New Zealand

British North African and Central Mediterranean Forces.

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270 CASUALTIES AND MEDICAL STATISTICS

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271

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272, CASUALTIES AND MEDICAL STATISTICS

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CHAPTER V

MIDDLE EAST FORCE

HAT PORTION of the British Army stationed in the Middle East

before the war consisted of Regular Units in Egypt, the Sudan,

Palestine and Cyprus. Soldiers were posted to the area for a
period of five years.

After the outbreak of war, the Command was re-inforced, not only
from Britain but also by Dominion and Colonial Units from India,
Australia, New Zealand, South Africa and East and West Africa.
In addition, there was a considerable amount of volunteer local recruit-
ment chiefly among Maltese, Cypriots and Palestinian Jews.

In January 1942, the Persia and Iraq Command (P.A.I.C.) was
absorbed by the Middle East Force, but in October of that year it was
divorced from M.E.F. and once more became a separate entity. Sub-
sequently, in February 1945, it was again absorbed. Similarly, in March
1942, troops in Malta came under the administration of M.E.F. until
May 1943. Aden also came under the control of the Command in 1943
and remained so at the end of 1945.

Before the war, hospitals rendered monthly statistical morbidity
returns on Army Form A.31. This return showed, inter alia, crude
figures of admissions and deaths by diseases. Returns were consolidated
at Command Headquarters and forwarded to the War Office. Hospital
Record Cards (Army Forms I.1220) which were maintained for each
patient and which included a summary of the case notes were forwarded
direct to the War Office by individual hospitals.

During the course of the war, a Medical Statistical Section was
established at the headquarters of the Officer i/c 2nd Echelon (O2E).
A.Fs. A.31 which, contrary to the practice in the United Kingdom
where the compilation of these forms was abandoned, were still in use
and were sent to that Section, as were A.Fs. I.1220. A.Fs. A.31 were
consolidated at the Section under the component Commands of M.E.F.
and further consolidated to produce medical statistics for the whole
Force.

For each year from 1942, annual Medical Statistical Reports contain-
ing the consolidations were published by O2E and from A.Fs. 1.1220
received from hospitals, several investigations were made which were
published in the ‘Statistical Report on the Health of the Army, 1943-
45’. A.Fs, I.1220 were eventually transmitted to the War Office.

As might be expected, the statistics produced by the Medical Statistical
Section at O2E were of a more detailed character than those obtainable
from the consolidated A.Fs. A.31 received in the War Office.

273

274 CASUALTIES AND MEDICAL STATISTICS

In the ensuing tabulations, statistics for the years 1939 and 1940 were
obtained from War Office records; those for 1941 from a report sub-
mitted to the War Office by Medical Branch, G.H.Q., M.E.F., while
those for the years 1942-45 were extracted from the Annual Statistical
Reports produced by O2E. From the information in the 1942-45
reports it has been possible to present data regarding the ethnic groups
of which the Force was composed.

Two defects from which the reports suffered were that they did not
report information regarding personnel invalided from the Command,
neither are statistics available regarding admissions and deaths for
Officers and Other Ranks separately.

As far as can be ascertained, there is no reason to doubt in any marked
degree the accuracy of the statistics here presented. All sources are
reliable and data for the years 1941-45 have been obtained from original
documents. The reports show comparatively few undiagnosed cases at
the end of each year and these have been included in ‘all other diseases’.

The tabulations which follow show the rates per 1,000 strength of
admissions to and deaths in HosPITALs only. No low grade morbidity
is included.

The following tables relating to admissions and deaths are presented:

Table Nos.
Period [$$ —_—________
Class of Personnel Covered Admissions Deaths
All Troops 7 . 1941-45, 54 68
United Hingdoin Troops y * 1939-45 55 69
Indian Troo a 5 1941-45 59 Jo
Dominion roops 3 6 4 1942 56 1
South African Troops Z 4 1943-45 57 s
New Zealand Troops : 2 1943-45 58 73-74
British African Troops a “ 1943-45 60 75
Other British Troops . . 1944-45 61 76
Women’s Services. a 2 1942-45 62 77
All Other Troops’. Ri 1942-45 63 72
All Troops By Commands ‘ 1942-45 64-67 79-82

The morbidity rates for All Troops (Table 54) show a steady decline
throughout the years 1941 to 1945, from 585 per 1,000 in 1941 to 357
in 1945. Factors which may have affected this are:

(i) The rapid acclimatisation of Troops in the Command.

(ii) With the exception of a comparatively small number of local
enlistments, newcomers to the Command were trained and
somewhat accustomed to the rigours of Army life.

(iii) Troops sent to the Middle East were of at least a fairly high
medical category. Those considered unfit for duty in a sub-
tropical climate were retained at home.

THE ARMY MEDICAL SERVICES 275

(iv) Those who were invalided were evacuated from the Command
and some subsequently retained in the Army in a low medical
category. They were then possibly more susceptible to disease
and became a medical liability of the country to which evacuated.

(v) The prompt effective measures taken by the Army medical
authorities to prevent and control disease.

The admission rates for DYSENTERY may possibly be cited in exem-
plification of this last factor. If the annual mean strength of All Troops
in 1941 is taken as 1,000 the relative strengths for the ensuing years
with relevant admission rates for Dysentery may be shown as below.

Year 1941 1942 1943 1944 1945
Relative Strength : 2 . | 1,000 1,937 1,696 1,080 1,108
Rates of Admission for Dysentery . 32 33 33 38 29

The admission rates for DIPHTHERIA showed a decline from 5 in 1941
to o-5 in 1945. The rate for INFECTIVE HEPATITIS in 1945 was approxi-
mately half that in 1942.

MALARIA increased from 21 in 1941 to 34 in 1944 and fell to one half
the latter rate in 1945. This trend in 1945 is noted in other Commands.
SANDFLY FEVER declined steadily and remarkably from 36 in 1941 to
5 in 1945. Against this, however, PYREXIA OF UNKNOWN ORIGIN (P.U.O.)
rose considerably. It is possible that, due to faulty diagnosis on the
part of Medical Officers with no great experience in tropical diseases,
many of the cases placed under this heading should have been allocated
properly to some of the febrile diseases. The rates for P.U.O. were
1941—8, 1942—9, 1943—20, 1944—23, and 1945—18 per 1,000
strength.

Admissions on account of scaBigs declined from 14 in 1941 to 4 in
1945, as did diseases of the skIN and I.A.T. from 63 to 43.

The rates for VENEREAL DISEASES dropped from 41 in 1942 to 23 in
1943, rose to 30 in 1944 and 39 in 1945.

Apart from 1942 when the rate was 3 per 1,000, admissions on account
of EFFECTS OF HEAT remained steady at between 0-2 and 0-5.

Admissions for MENTAL DISEASES increased to 14 in 1942 from 7 in
1941, and declined steadily during the next three years to 6 in 1945.
The rates for NERVOUS DISEASES fell from 14 in 1941 to 7 in 1942 and,
finally, to 4 in 1945.

Admissions for rnJuRIEs through ENEMY ACTION were 35 in 1941,
31 in 1942, 22 in 1943, 0-77 in 1944 and 0-06 in 1945. Rates for INJURIES
not caused by enemy action (N.E.A.) declined some months after the

10CMS

276 CASUALTIES AND MEDICAL STATISTICS

conclusion of active operations. Figures for the years 1941 to 1945
were 49, 48, 49, 43 and 34 respectively.

Tables 55 to 60 record the rates of admissions to hospitals according
to ethnic groups and Tables 61 to 63 those of Other British Troops,
Women’s Services and All Other Troops respectively. Table 56 relates
to Dominion Troops (1942) which included those from Australia,
New Zealand, and South Africa. Separate figures are available for the
latter two classes from 1943 to 1945, while Australians, being very few
in number, are included in ‘Other British Troops’. All Other Troops
include those of other nationalities, e.g. Poles, Cypriots, Palestinian
Jews, etc., in the Command.

Comparison of Tables 55 to 60 discloses the following outstanding
features:

(i) United Kingdom Troops were more prone to DIPHTHERIA,
EFFECTS OF HEAT, TONSILLITIS and SKIN DISEASES.

(ii) Troops of the United Kingdom and New Zealand were more
susceptible to INFECTIVE HEPATITIS but less prone to TUBER-
CULOSIS.

(iii) Indian Troops were less prone to DIPHTHERIA and PNEUMONIA
but more prone to MALARIA and, especially, to EYE DISEASES.

(iv) Native African Troops were particularly prone to DYSENTERY,
PNEUMONIA, SCHISTOSOMIASIS and BRONCHITIS but were con-
spicuously less prone to MALARIA.

(v) Indian and Native African Troops were less prone to INFECTIVE
HEPATITIS, INFLUENZA, DISEASES OF THE EAR AND NOSE and,
particularly, TONSILLITIS, but were more prone to MUMPS and
TUBERCULOSIS,

vi) Sou! rican Troops were less prone to DYSENTERY but more
South Afi Troop: less p t but
susceptible to MEASLES and TUBERCULOSIS.

vii) Sout rican and New and Troops were more prone to
South Afi d New Zealand Troop: P t
INFLUENZA.

(viii) Troops of African domicile were more prone to VENEREAL
DISEASES than were the other groups.

ix) Troops of Euro) ock were more liable to MENTAL DIS
Troops of European Stock liable t EASES
than were non-European.

These indications are tabulated below:

THE ARMY MEDICAL SERVICES

277

Ethnic Group

Disease Prone
Diphtheria British
Dysentery Native Africans

Infective Hepatitis
Influenza

Malaria

Measles

Mumps
Pneumonia
Tuberculosis
Venereal Diseases
Effects of Heat
Mental Diseases
Bronchitis
Tonsillitis

Ear and Nose Diseases
Eye Diseases

Skin Diseases
Schistosomiasis

British, New Zealanders

South Africans, New Zealanders
Indians

New Zealanders

Indians, Native Africans
Native Africans

South Africans, Native Africans
South Africans, Native Africans
British

European Stock

Native Africans

British

Indians

British

Native Africans

Less Prone

Indians

South Africans

Indians, Native Africans
Indians, Native Africans
Native Africans

Indians
British, New Zealanders

Non-European Stock
Indians, Native Africans
Indians, Native Africans

Tables 64 to 67 exhibit the rates per 1,000 strength of admissions
to hospitals of All Troops by the various Commands within the frame-
work of the Middle East Force. From these tables the following emerges.

(i) DIPHTHERIA was more prevalent in Egypt (1942, 1943) than
elsewhere. The incidence of this disease decreased there from
3°5 in 1942 to 0-4 in 1945.

(ii) The highest rates of hospitalisation for DYSENTERY also occurred
in Egypt.

(iii) MALARIA was more rife in the Sudan and Eritrea than in other
Commands. There was a conspicuous fall in the incidence of
this disease in 1945 in all areas, the most dramatic being in
Sudan and Eritrea where the rates for 1943, 1944 and 1945
were 134, 98 and 27 respectively. It is interesting to note the
continuous steady fall of Malaria cases in Cyprus from 43 in
1942, to 24 in 1943, 13 in 1944 and, finally, to 10 in 1945.

(iv) Extremely high rates for PNEUMONIA occurred in Cyrenaica in
1944 and 1945, the figures being 24 and 12 respectively as
against the all M.E.F. rates of 6 and 4.

(v) SANDFLY FEVER accounted for numerous admissions to hospital
in Cyprus and, apart from 1943, the rates were over twice as
high as those in the Command next in order of high rates for
this disease.

(vi) Admissions for scaBres were also conspicuously much higher
in Cyprus than elsewhere,

(vii) veNEREAL DISEASES increased over the years 1942-45 in Syria,
where the admission rate in 1945 was four times that of 1942

278 CASUALTIES AND MEDICAL STATISTICS

(42 and 13 respectively), in Cyprus, where the 1945 rate was
just over three times that of 1942 (135 and 43) and at Aden
where the 1945 rate was slightly over four times that for 1942
(70 and 16).

(viii) While the admission rate for BRONCHITIS rose steadily in Syria
from 5 in 1942 to 15 in 1945 and in Aden (from 6 to 22 in the
same years), in all other Commands for which statistics are
available for those years, the rates declined.

(ix) TONSILLITIS was more prevalent in the Sudan and Eritrea,
followed by Cyprus with Egypt a close third. The lowest rate
for this disease occurred in Aden.

(x) Diseases of the skIN occurred more frequently in Aden, Cyprus
and the Sudan and Eritrea.

Tables 68 to 82 show the causes and rates of deaths in military
hospitals. Table 68 refers to All Troops, Tables 69 to 78 to the various
classes of troops, while Tables 79 to 82 break down the data in Table 68
to the component Commands of M.E.F.

Apart from 1941, when the rate was 0-92 per 1,000, deaths of all
troops from disease fluctuated only slightly, the highest rate being
1-69 and the lowest 1-28.

TUBERCULOSIS accounted for the largest number of deaths, rising from
0-03 in 1941 to a peak of 0-46 in 1944. The rate in 1945 was 0-41. The
mortality rates for this disease were highest among Indian and Native
African Troops. The relevant figures are:

Year Indians Native Africans | All Troops
1943 0°50 o-8r o'2r
1944 rig 1°4t 0°46
1945 0°56 1°03 o°41

Other Diseases of the picEstive System were responsible for the
next highest number of deaths, the rates being 0-11 in 1941, 0-19 in
1942, 0°14 in 1943 and 1944, and o-11 in 1945.

Deaths from INJURIES not attributable to Enemy Action were from
one third to one quarter of the total number of deaths from injuries and
disease, the rates being:

Injuries-N.E.A. . o°77 102 0°74 069 0°48
Total Deaths - . 2:16 3°31 2°44 2°39 0°97
Percentages C : 35 3t 30 29 27

THE ARMY MEDICAL SERVICES 279

Summary

Admissions to hospitals on account of disease steadily declined from
one in every two persons in 1941 to one in every three in 1945.

The main causes of admission were DYSENTERY, MALARIA, P.U.O.,
VENEREAL DISEASES, diseases of the RESPIRATORY and DIGESTIVE SYSTEMS
and diseases of the SKIN.

As in other malarious areas, the rates of admission for MALARIA
showed a substantial reduction in 1945. The most striking and steady
decline in admissions was in respect of SANDFLY FEVER, the rate for which
in 1945 was one seventh that in 1941.

280 CASUALTIES AND MEDICAL STATISTICS

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THE ARMY MEDICAL SERVICES

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282, CASUALTIES AND MEDICAL STATISTICS

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283

THE ARMY MEDICAL SERVICES

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284 CASUALTIES AND MEDICAL STATISTICS

TABLE 56

Middle East Forces. Admissions to Hospital, 1942. Dominion Troops*
Annual rates per 1,000 Strength

Source: Annual Report O.2.E, G.H.Q., M.E.F.

CAUSES OF ADMISSION

1 Diphtheria 1
2 Dysentery . ‘ 2
3 Enteric Group of Fevers 3
4 | Infective Hepatitis . 4
. 5

i i
7 1°37 7
8 0°73 8
9 4°93 9
10 5°86 10
11 13°70 11
12 Relapsing Fever 0°43 12
13 | Rheumatic Fever 0°99 13
14 | Sandfly Fever. 13°94 14
15 | Schistosomiasis 0°47 15
16 | Smallpox i _ 16
17. | Tuberculosis 2°07 17
18 | Typhus Fever orm 18
19 | Scabies . ‘, a 5 « < 6:67 19
20 | Venereal Diseases—Gonorrhoea : - . : 20
21 | Venereal Diseases—S: ais : f - 2 21
22 | Venereal Di if : F . 2 22
23 Total Venereal Diseases 2 z : ¢; ‘ u 23
24 | Effects of Heat 4 . 7 is : ‘ 4 <i 24
25 Mental Diseases. . . q . % : * 25
26 | Nervous Diseases . : : % ’ ‘ R 26
27 | Valvular Disease of the Heart x : ‘ . 27
28 | Other Diseases of the Circulatory System %. | : : 28
29 | Inflammation of the Bronchi . ; ‘ . 7 29
30 | Other Diseases of the Respiratory System “ . : G 30
31 | Inflammation of the Tonsils . 5 ’ : 31
32 | Other Diseases of the Digestive System : ‘ 3 B 32
33 | Diseases of the Ear and Nose . . A : x 33
34 | Diseases of the Eye . * x si 34
35 Skin and I.A.T. (excluding Scabies) | @ “ . 2 35
36 | All Other Diseases 3 z y ‘, . 36
37 Total Admissions for Diseases . é - 5 . 37
38 | Injuries—N.E.A. . ; is ‘ : rs 5 7 38
39 | Injuries—E.A. 4 A m . . e - 39
40 Total Admissions for Injuries. F : s : 40
41 Total Admissions . i : . . . : 41

* Dominion Troops consisted of Australian, New Zealand and South African Forces.

THE ARMY MEDICAL SERVICES

285

‘TABLE 57

Middle East Forces. Admissions to Hospital, 1943-45. South African Troops
Annual Rates per 1,000 Strength

Source: 2nd Echelon M.E.F. Annual Reports

CAUSES 1943 1944 1945
1 Diphtheria 4 0-3: 0-92 o-18 1
2 Byeentery 17" 22°35 II'I4 2
3 Enteric Group of Feyers 0°39 0°40 on 3
4 Infective Hepatitis—T: } 5°64 { 4:36 od 4
5 Infective Hepatitis —Post-Arsphenamine 0°83 0-80 5
6 Influenza . . 5°13 6°50 1°64 6
z Malaria. . 13°99 14°59 13°22 rf
8 Measles. . 1°52 0°20 0°04
9 Meningococcal Infection o-12 0°40 _ 9
10 Mumps . * 2°39 0°56 0°66 10
au Pneumonia 3°08 4°16 2°95 1
12 P.U.O, - 13°85 21°26 17°99 12
3 Relapsing Fever o-2r _ ors 13
4 Rheumatic Fever 0°23 0°26 0-07 14
15 Sandfly Fever 17°73 4°32 2°37 15
16 | Schistosomiasis 0°94 0-92 0°33 16
v Smallpox .| s i 0°37 0°46 _ 1
1 : : 2°37 3°14 2°33 1
19 Typhus . 2: - 0-05 O13 0744 19
20 Venereal Diseases—Syphilis N. 134: 13°44 20
21 Venereal Diseases- N. 7 3} by it id a1
22 Venereal Diseases—Other Forms N. 30-00 38+ 22
23 Total V.D. . . . 35715 51°38 “4 23
24 Scabies 3°45 6-30 18°10 24
2 Effects of Heat . 0°23 0-07 or 2
2 Mental Diseases—Psychoses 3°17 4°92 3:78 at
27 Nexeal Diseases—Paychoneuroses 11°22 ra:ce + 2
28 Nervous Diseases 3°91 "22 3°90 2
29 Valvular Disease of the 0°62 rat 0°33 29
30 Other Diseases of the Circulatory System 6-58 6: 1°97 30
31 Inflammation of the Bron: 12-28 16-93 8-99 31
32 Diseases of the Respiratory “System g'52 10°10 5°50 32
33 Inflammation of the Tonsils . 13°78
34 Other Diseases of the mare System 42°3!
3 Diseases of the Ear and + 16-98
3 Diseases of the Eye 4:59
37 meee ol he and LA.T. 38-90

286 CASUALTIES AND MEDICAL STATISTICS

TABLE 58

Middle East Forces. Admissions to Hospital, 1943-45. New Zealand Troops
Annual Rates per 1,000 Strength

Source: and Echelon M.E.F. Annual Reports

CAUSES

Lapeceetcy
toa

Borene Cr ‘
Enteric Group of Fevers
Infective Hepatitis—True
Infective Hepatitis—Post-.

Sh

»
”

Ow Go00%N o©000

Re so] Su

q an | com
28 33

& Rava Ls

ealas

Pata

t
2"

ced

Larter}
S89 déis deal gz

aan oot the Heovintory Syste

Inflammation of the Tonails
Other Diseases of of the Digestive System
Baas oe Bre rar

Busto oun

2
od
on

(excl.
All Other Diseases
Total Diseases

Injuries—E.A.
Injuries—N.E.A.

Total Injuries .
Total Admissions.

x
<
oo
&

‘TABLE 59

Middle East Forces. Admissions to Hospitals, 1941-45. Indian Troops, Annual Rates per 1,000 Strength

THE ARMY MEDICAL SERVICES

a3

T RRR

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3 ngne
SS Seee :

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Total V.D.

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3
8

288 CASUALTIES AND MEDICAL STATISTICS

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(‘piu02)—6S alavy,

THE ARMY MEDICAL SERVICES 289

TABLE 60

Middle East Forces
Admissions to Hospitals, 1943-45
British African Troops
Annual Rates per 1,000 Strength
Source: 2nd Echelon M.E.F. Annual Reports

1 Diphtheria. 0-07 1
2 ntery é 11714 2
3 Enteric Group of Fevers 0°34 3
4 fective Hepatitis—True
5 Infective Hepatitis—Post- ‘Arsphena- | 3:02 4
mine 0-62 s
6 Influenza * 1°32 6
z Malaria : 4:96 3
Measles . on
9 Meningococcal Infection od 9
1o | Mumps z “n 10
" . 8- a
12 P.U.O, beke 22° 12
1 Relapsing Fever o- 1
a Rheumatic Fever o- A
15 Sandfly Fever. mr 1s
16 Schistosomiasis . 3 16
' Smallpox. i o *
ry Tu . a u
19 ‘Typhus e ‘ o 19
20 Venereal Diseases—Syphilis . 19°87 20
21 Diseases 14°87 ar
22 Venereal Diseases—Other Forms 44°13 22
23 Total V.D. ; 78-8 23
24 bies . 3 24
2, Heat oO" 35
2 Mental Discases—Psychoees 2"
3 Mental Diseases— 3° 4
Ne Diseases a
29 Valvular Disease of the Heart o 29
jo. oe Diseases of the Circulatory
: 2 0
31 Tanimanation of the E Bronchi - ar EH
33 Other Diseases of the Respiratory
System . ¥ 32
33 Inflammation of the Tonsils “45 5° 33
4 Other Di Diseases of the Digestive
. 47 43°
3 Distances of the Ear and Nose | “44 ‘% ae
3 Diseases of the E) ‘00 8: 3
37 Diseases of the skin and IL AT.
(excl. Scabies) “77 37
38 All Other Diseases +86 38
39 Total Diseases “42 39
~ Injuries—E.A. 89 “~
4r Inuries—NELA. *is 4r
42 Total Injuries ‘02 42
3 Total Admissions 43

Noter rue term ‘British African’ includes all native personnel from British Territories
in ica.

290 CASUALTIES AND MEDICAL STATISTICS

TABLE 61
Middle East Forces

Source: Annual Report O.2.E., G.H.Q., M.E.F.

COI ANAWDH

41
42

Admissions to Hospitals, 1944-45

Other British Troops

Annual Rates per 1,000 Strength

CAUSES 1945
Diphtheria > G 0°31
Dysentery z 21°95
Enteric Group of Fevers 0°54
Infective Hepatitis . : : 8-01
Influenza - é . A eu
Malaria A a F 19°58
Measles . 7 . 5 0°50
Meningococcal Infection ‘ Orrs
Mumps . 2°30
Pneumonia A 7m 3°91
P.U.O. 7 fs Ps 26-78
Relapsing Fever ‘ A 5 0°31
Rheumatic Fever. ‘ 7 0-08
Sandfly Fever . 1°23
Schistosomiasis 0°23
pane . ‘ 9°77
mallpox . 7 0-19
Tuberculosis 2°76
Typhus Fever : ovrr
Venereal Diseases—Gonorrhoea 25°67
Venereal Diseases—S: 120-00
Venereal Di: rey 37°85
Total V.D. fs 3°52
Effects of Heat ! * 0°27
Mental Diseases—Psychoses . 4°56
Mental Diseases—Psychoneuroses 9°39
Nervous Diseases. . 3°33
Valvular Disease of the Heart | 0°27
Other Circulatory Conditions . 4°18
Inflamation of the Bronchi s 14°71
Other Diseases of the Respiratory
System ui : 5 By 10°19
Inflammation of the Tonsils é 29°85
Other Diseases of the Digestive
System ¢ 3 59°92
Diseases of the Ear and Nose . 14°09
Diseases of the Eye . 12°03
Skin and 1.A.T. (Ceding Scabies) ; 57°43
All Other Diseases . 89°85
Total Admissions for Diseases 493°40
Injuries—N.E.A.. ¢ % 40°04
Injuries—E.A. 3 J , 0°31
Total Admissions for Injuries 40°35
Total Admissions ‘ ‘ . 783 °38 533°75

© oon! rye

Note: The term ‘Other British Troops’ refers to all male personnel from British
Territories outside Africa and not included in Tables 55 to 60.

THE ARMY MEDICAL SERVICES 2g1

TABLE 62

Middle East Forces
Admissions to Hospitals, 1942-45
Women’s Services
Annual Rates per 1,000 Strength

Source: 2nd Echelon M.E.F. Annual Reports

Z

CAUSES

Diphtheria

Stheeting: Ee of Fevers :

Infective Hepatitis—True .

Infective Hepetitie bow
Arsphenamine 5

Be! LOO O.G
% Saree

Su io

a nnoke ooo
.y SSS3S SEs

O°
2
x
o
o
ve
oO 14

Seno wo

Valvular Disease of the Heart
Other Diseases of the
Infiaramstion of the Broochi
Other Diseases of the
Respiratory System
Inftammation of the Tonsile
Other Diseases of the Digestive
Distuscr of the Ear and Nowe |

Disesoen of the Fi
of the Skin and LAT."
Dicitiading’S jcabies)

All Other Diseases*
Total Diseases

Injuries—E.A.
Injuries—N.E.A.

Total Injuries
Total Admissions

© Inchudes diseases listed ‘N.A.’
Note: The term ‘Women’s Services’ includes all female personnel of all Forces in M.E.F.

292 CASUALTIES AND MEDICAL STATISTICS

TABLE 63

Middle East Forces
Admissions to Hospitals, 1942-45
All Other Troops
Annual Rates per 1,000 Strength

Source: Annual Reports O.2.E., G.H.Q., M.E.F

CAUSES
Diphtheria .
Dysentery . :
Enteric Group of Fevers
Tafective Hepatitis .

3

gkunoe Busnbe

2 neces

Valvular Die Disease of the Heart
tory Conditions

EnBameetion of ne Bronchi .
Other Disesées o f the Respiratory

Infimenation of the Tonsils |

Orber | Disesies of the Digestive

Distance of the Ear and Nowe |

Diseases of the Eye .

Skin and I.A.T. (excluding
Scabies). : . :

N.
N.
N.
N.
N.
N.
8
N..
12
N.
N..
N.,
N..
N..
Nu.
24°
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Ny
Nu.
N.
6:
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Nu

3 Z8ZeZ ZZZZZZ
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Total Admissions for Diseases .

Injuries—N.E.A.
Injguries—E.A. .

Total Admissions for Injuries
Total Admissions

* Includes diseases listed ‘N.A.’ (except V.D.).
Note: The term ‘All Other Troops’ refers to all Dominion, Colonial and Allied male
personnel (excluding U.S. personnel) not included in Tables 55 to 62.

293

THE ARMY MEDICAL SERVICES

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294 CASUALTIES AND MEDICAL STATISTICS

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295

THE ARMY MEDICAL SERVICES

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296 CASUALTIES AND MEDICAL STATISTICS

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297

THE ARMY MEDICAL SERVICES

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TABLE 67
Middle East Forces. Admissions to Hospitals, 1945. All Troops. By Commands
Annual Rates per 1,000 Strength

0.2.E., G.H.Q., M.E.F.

‘CAUSES

Other Diseases of the Circulatory System

Mental Diseases—Psychoneuroses
Nervous Diseases. 3 s:
Valvular Disease of the Heart .

Mental Diseases—Psychoses

F

299

THE ARMY MEDICAL SERVICES

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300 CASUALTIES AND MEDICAL STATISTICS

TABLE 68

Middle East Forces
Deaths in Hospital, 1941-45
All Troops
Annual Rates per 1,000 Strength

Source: Annual Reports O.2.E., G.H.Q., M.E.F.

CAUSES

“y [Diphtheria =... ~~~ | 0-04 | 0-05 | 0-02 | oor | — |
Dysentet

Enteric Group of Fevers

PPARs
desl li

1

2

3 Infective Hepatitis

4 infective Hepa

Fi Influenza .
Malaria.

9

0

1

2, e000
1gg

©, 000

S
3

Measles.
Meningococcal Infection
Pneumonia

P.U.O.

Relapsing Fever’

eoo
lgggl

$I
mSees, ouxous

g!3a8

12. | Rheumatic Fever

3 Schistosomiasis o-or = 13
4 Smallpox 0:0: 0:00 4
1 Tuberculosis °: o-4t 1
1 ‘Typhus Fever o-or — t
17 Venereal Diseases 0-00 0:00 17
18 | Other Diseases due to Infection . - 18
19 Effects of Heat . ‘ oo 19
20 Mental Diseases—Psychoses . oO 20
ar Mental Discsses— Psy eeneurcecs oo ar
22 | Nervous Diseases . oO 22
a3 Valvular Disease of the Heart ‘ oO a3
24 Other Diseases of the Respiratory:
System $ o 24
35 Inflammation of the Bronchi Oo as
Oter Diseases of the Cir 6
: : oO:
2 Infueenation of the Tonsils’ . on 2
ai Other Diseases of the petive System oO 4
29 | Diseases oe the Eee and . Oo 29
30 | Diseases o! oO 30
31 | Skin and iNT Fre ing 3 Scabies) or 31
32 | All Other Diseases . < : o 32
33 Total Deaths from Diseases I 33
34 | Injurin—NEA 2. ° 4
3s | Injuriee—E.A. . . o- 3s
36 Total Deaths from Injuries . oO. 36
37 Total Deaths . . . . . 37

THE ARMY MEDICAL SERVICES 301

TABLE 69

Middle East Forces
Deaths in Hospital, 1941-45
United Kingdom Troops
Annual Rates per 1,000 Strength

Source: Annual Reports O.2.E., G.H.Q., M.E.F.

(a) Included in ‘All Other Diseases’.

302 CASUALTIES AND MEDICAL STATISTICS

TABLE 70
Middle East Forces
Deaths in Hospital, 1941-45
Indian Troops
Annual Rates per 1,000 Strength

Source: Annual Reports O.2.E., G.H.Q., M.E.F.

CAUSES 1941 1942 1945
1 Diphtheria — _- a
2 | Dysente: 0:06 0-03
q Enteric Group of Fevers _- 0-02
4 Infective Hepatitis _- 0°03
3 luenza . - - -
Malaria 0°04 0°04 o-or
3 Measles _- _- _
Meningococcal Infection os 0°07 =
9 | Mumps pa = _
10 | Pneumonia O04 0-06 0-03
ir | P.U.O. 0°04 o-or -
1a | Relapsing Fever” = pos a
13° | Rheumatic Fever - - -
14 | Schistosomiasis - = =
1 Smallpox . 0-02 o-or _-
1 Tuberculosis 0-06 or13
t ‘Typhus Fever - —
i Venereal Discases - o-oz
19 | Effects of Heat . - 0:07 ras
20 | Mental Diseases. = o-or ovor
ar Nervous Diseases é 0-04 0-03 0°04
a2 | Valvular Disease of the Heart | - — o-or
23 Other Diseases of the Circulatory
System . . : . o-oz 0-08
24 Inflammation of the Bronchi ‘ 0-02 =_-
as Other Diseases of the Respiratory:
System . 0-04 0°02
26 Inflammation of the Tonsils . _ —
by4 Other Diseases of the jive System. 0°02 0°09
Diseases of the Ear and Nose . - seg
29 | Diseases of the Eye - -
30 Skin and 1.A.T. (Cxchiding Scabies) 0-02 o-or
3I All Other Diseases orr4 0-19
32 Total Deaths from Diseases 0°54 1er2
33 Injuries—N.E.A. 0-26 0°65
34 Injuries—E.A. . 0°24 0°03

3s Total Deaths from Injuries
36 Total Deaths .

OOr ANdWAH

THE ARMY MEDICAL SERVICES

TABLE 71

Middle East Forces
Deaths in Hospital, 1942
Dominion Troops*
Annual Rates per 1,000 Strength

Source: Annual Reports O.2.E., G.-H.Q., M.E.F.

Diphtheria

Dysentery

Enteric Group of Fevers

Infective Hepatitis .

Influenza . i
ria

Measles .
Meningococcal Infection

Relapsing Fever

Rheumatic Fever
Sandfly Fever
Schistosomiasis
Smallpox .
Tuberculosis
Typhus Fever

Scabies

Venereal Diseases

Effects of Heat .

Mental Diseases .

Nervous Diseases

Valvular Disease of the Heart

Other Diseases of the Circulatory System.
Inflammation of the Bronchi

Other Diseases of the Respiratory | System
Inflammation of the Tonsils :

Other Diseases of the Digestive System™
Diseases of the Ear and Nose : .

Diseases of the Eye.
Skin and 1.A.T. (excluding Scabies)
All Other Diseases.

Total Deaths from Diseases

Injuries—N.E.A. : 7
Injuries—E.A. . a .

Total Deaths from Injuries
Total Deaths . .

303

© corr ae |

* Dominion Troops consisted of Australian, New Zealand and South African Forces

304 CASUALTIES AND MEDICAL STATISTICS

TABLE 72
Middle East Forces
Deaths in Hospital, 1943
New Zealand and South African Troops
Annual Rates per 1,000 Strength

Source: Annual Reports O.2.E., G.H.Q., M.E.F.

CAUSES

|

Diphtheria

Dysentery

Enteric Group of Fevers
Infective Hepatitis
Influenza .

Malaria

Measles.
Meningococcal Infection

COT Anew na

12 Relapsing Fever

13. | Rheumatic Fever
14 | Sandfly Fever

15 Schistosomiasis
16 herent

17 ‘mal

18 | Tuberculosis

0°
a9

Bere)

19 | Typhus Fever

20 | Venereal Diseases

21 | Effects of Heat .

22 | Mental Diseases —Psychoses

23 | Mental Diseases—Psychoneuroses
24 | Nervous Diseases ; . 5

25 | Valvular Disease of the Heart

26 | Other Circulatory Conditions

27 | Inflammation of the Bronchi

28 | Other Diseases of the Respiratory ‘System
29 Inflammation of the Tonsils

30 | Other Diseases of the Digestive System™

31 Diseases of the Ear and Nose

32 | Diseases of the Eye

33 | Skin and LA.T. (Cxchiding Scabies)
34 | All Other Diseases

35 Total Deaths from Diseases

36 | Injuries—N.E.A.
37 Injuries—E.A.

38 Total Deaths from Injuries
39 Total Deaths .

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THE ARMY MEDICAL SERVICES 305

‘TABLE 73

Middle East Forces
Deaths in Hospital, 1944-45
South African Troops
Annual Rates per 1,000 Strength

Source: Annual Reports O.2.E., G.H.Q., M.E.F.

Diphtheria .

tery
Enteric Group of Fevers
Infective Hepatitis
Influenza °
Malaria

Measles.
Meningococcal Infections

Mumps.

Pneumonia

Relapsing Fever |
Rheumatic Fever
Sandfly Fever

Typhus Fever

Venereal Diseases

Effects of Heat.

Mental Diseases—Psychoses . :
Mental Diseases —Paychoneuroses «
Nervous Diseases

°

°
g

Valvular Disease of the Heart

Other Circulatory Conditions
Inflammation of the Bronchi

Other Diseases of the Respiratory System
Inflammation of the Tonsils a
Other Diseases of the Digestive System

Diseases of the Ear and Nose
Diseases of the Eye

Skin and 1.A.T. (Cxctuding Scabies)
All Other Diseases

Total deaths from Diseases

Ltt gig lag

°
»
a

Injuries—N.E.A.
Injuries—E.A.

Total Deaths from Injuries
Total Deaths

306 CASUALTIES AND MEDICAL STATISTICS

TABLE 74

Middle East Forces
Deaths in Hospital, 1944-45
New Zealand Troops
Annual Rates per 1,000 Strength

Source: Annual Reports O.2.E., G.H.Q., M.E.F.

Our wnn

Diphtheria .

Dysentery .

Enteric Group of ‘Fevers
Infective Hepatitis
influenza

Malaria

Measles.
Meningococcal Infection
Mumps zi
Pneumonia

P.U.O. : -
Relapsing Fever .

Rheumatic Fever
Sandfly Fever
Schistosomiasis
Scabies
Smallpox .
Tuberculosis

Typhus Fever

Venereal Diseases

Effects of Heat

Mental Diseases—Psychoses . é
Mental Diseases—Psychoneuroses .
Nervous Diseases

Valvular Disease of the Heart

Other Circulatory Conditions
Inflammation of the Bronchi

Other Diseases of the Respiratory System
Inflammation of the Tonsils <
Other Diseases of the Digestive System

Diseases of the Ear and Nose
Diseases of the Eye
Skin and I.A.T. (excluding Scabies)
All Other Diseases ‘

Total Deaths from Diseases

Injuries—N.E.A.
Injuries—E.A.

Total Deaths from Injuries
Total Deaths

OUPWN A

THE ARMY MEDICAL SERVICES 307

‘TABLE 75

Middle East Forces

Deaths in Hospital, 1943-45
British African Troops

1 | Diphtheria . r

2 | Dysentery . 2

3 | Enteric Group of Fevers. 3

4 Infective Hepatitis. 4

5 influenza. 2 5

6 | Malaria 6

7 +| Measles 7

8 Meningococcal Infection 8

9 9
10 10
qr . : : : . Zi . 1
12 | Relapsing Fever . : ‘ . y 12
13 | Rheumatic Fever . _- 13
14 | Sandfly Fever _ 14
15 Schistosomiasis _ 15
16 | Scabies _ 16
17 | Smallpox. 0°02 17
18 | Tuberculosis 1°03 18
19 | Typhus Fever _— 19
20 | Venereal Diseases . os 20
21 | Effects of Heat ‘ = ar
22 | Mental Diseases—Psychoses ‘ 0:06 22
23 Mental Diseases—Psychoneuroses _- 23
24 | Nervous Diseases a 0°06 24
25 Valvular Disease of the Heart 08 a5
26 | Other Circulatory Conditions . *33 26
27 Inflammation of the Bronchi . "02 27
28 | Other Diseases of the Respiratory System. our 28
29 Inflammation of the Tonsils . ‘, 29
jo | Other Diseases of the Digestive System fs 7 ; : go
31 | Diseases of the Ear and Nose . . ‘ : 31
32 | Diseases of the Eye , 32
33 | Skin and I.A.T. (excl. Scabies) “ : 33
34 «(| All Other Diseases 2 . 2 “ . 34
35 Total Deaths from Diseases. a G 5 . 35
36 | Injuries—N.E.A. . ‘ + : 36
37 =| Injuries—E.A. s < 4 é . 37
38 Total Deaths from Injuries : : : 38
39 Total Deaths . ce a 39

Note: The term ‘British African’ includes all native male personnel from British
Territories in Africa.

1ICMS

308 CASUALTIES AND MEDICAL STATISTICS

TABLE 76

Middle East Forces
Deaths in Hospital, 1944-45
Other British Troops
Annual Rates per 1,000 Strength

Source: Annual Reports O.2.E., G.H.Q., M.E.F.

1 Diphtheria
2 tery
3 Enteric Group of Fevers
4 Infective Hepatitis .
5 Influenza a
é :
7
8
9

10

1

12 Relapsing Fever

13 Rheumatic Fever

14 Sandfly Fever.

15 5 che

16

5

1

19

20

21 Effects of Heat

22 Mental Diseases

23 Nervous Diseases

24 Valvular Disease of the Heart

a5 Other Circulatory Conditions

26 Inflammation of the Bronchi_. :
27 Other Diseases of the Respiratory System 2
28 Inflammation of the Tonsil:

29 Other Diseases of the Digestive System
go Diseases of the Ear and Nose
31 Diseases of the Eye

32 Skin and LA.T. (Gxcl. Scabies)
33 All Other Diseases 5

34 Total Deaths from Diseases

35 Injuries—N.E.A.
36 Injuries—E.A.

37 Total Deaths from Injuries
38 Total Deaths

Note: The term ‘Other British Troops’ refers to all male personnel from British
Territories outside Africa and not included in Tables 69 to 75.

THE ARMY MEDICAL SERVICES 309

TABLE 77
Middle East Forces
Deaths in Hospital, 1942-45
Women’s Services
Annual Rates per 1,000 Strength

Source: Annual Reports 0.2-E., G.H.Q., M.E.F.

Diseases of = 5 E
Skin and I.A.T. (excluding Scabies)

Total Deaths from Diseases
Injuriee—N.E.A.
Injuriee—E.A.

Total Deaths from Injuries

Total Deaths

310 CASUALTIES AND MEDICAL STATISTICS

TABLE 78
Middle East Forces
Deaths in Hospitals, 1943-45
All Other Troops
Annual Rates per 1,000 Strength

Source: Annual 0.2.E., G.H.Q., M.E.F.

1 Diphtheria « 1

2 2

3 Enteric Croup of Fevers © 3
4 Infective Hepatitis . . 4

Influenza e 7 3

3 Malaria

9 9
10 0-06 10
os - "
12 - 12
13 _- 13
4 - 4
1 - 1
1 - 1
1 — 1
1 O° 0-65 1
19 o-or - 19
20 - - 20
ar - - ar
az 0:06 o-o2 az
23 o-or - 23
24 0-03 0-06 a4
2 0-19 0-10 2
38 oro 0°06 8
2 ovor - 4
a 0°03 0-03
29 ra — 29
30 I oO 3°

2:
ot

31 | Diseases of thal Ear and Nose

gos 8

°
32 | Diseases of the E: o- 32
33 Skin and 1.A.T. (Gactuding Scabies) * oO 32
34 | All Other Diseases 0°39 34

ale

38 Total Deaths from Diseases
6 Injuries—N.E.A.

3 Injuries—E.A. .

38 Total Deaths from Injuries. . . . 9 R ¥ 38

39 Total Deaths. . : E 7 . : g 39

o
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* Any cases included in ‘All Other Diseases’.
Note: The term ‘All Other to all Dominion, Colonial and Allied male personnel
(excluding U.S. personnel) not inc! aad | in feeble 69 to 77.

311

THE ARMY MEDICAL SERVICES

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312 CASUALTIES AND MEDICAL STATISTICS

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313

THE ARMY MEDICAL SERVICES

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314 CASUALTIES AND MEDICAL STATISTICS

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zg a1av,L

CHAPTER VI
WEST AFRICA COMMAND

s in all other Commands, there is no complete morbidity and

traumatic data available for West Africa Command for the war

years. In so far as the Medical Index maintained by the Hollerith
Section ofthe War Officeisconcerned, rooper cent. of Army Forms I.1220
received fromthe Command for the years 1941 to 1945 were coded. These
forms, however, pertained to British Troops only. The preponderance of
troops in the theatre was of West African stock. It is therefore necessary,
in order to evaluate the relative importance of the incidence of disease
among the British and African troops stationed there, to rely upon
another source for data. The statistical reports for the period 1941-44
and for 1945 prepared by the local Army Health Authorities are avail-
able and this chapter summarises the information contained in these
reports.

Both reports are concerned with hospitalisation only (except with
regard to Venereal Diseases) and do not include any data relating to low
grade morbidity. They are not comprehensive in that only certain
diseases and injuries are included. They do not, as do those of some other
commands, give the incidence, for instance, of I.A.T., Psychiatric
Disorders, Scabies, etc. They do, however, draw an illuminating
picture of those diseases which have a greater incidence among per-
sonnel of one or other of the two groups concerned.

Apart from the incidence of the Dysenteries occurring among Euro-
pean Troops in 1944 (‘Table 85), there is no reason to doubt the accuracy
of the figures shown in the tables which follow.

Table 83 shows the rates of hospital admissions for both classes of
personnel. The Command rate for Europeans was consistently higher
than that for Africans, being in 1941 more than twice as high and in
1945 just under 20 per cent. higher. Throughout the period, the Com-
mand rate for Europeans steadily declined, whereas that for Africans
fluctuated without any characteristic trend. The reason for this was the
successful control of Malaria. This is exemplified by the fact that if the
Malaria rates are excluded, the figures for Europeans show no steady
decline and differ little from those for Africans.

Table 84 shows the comparative importance of different diseases.
Africans are relatively immune to Malaria, Bacillary and Amoebic
Dysentery. They are, however, relatively prone to V.D., Pneumonia,
Chickenpox and Tropical Ulcer. The high rate for Schistosomiasis in
1944 was largely due to a local outbreak in Nigeria.

315

11°cMs

316 CASUALTIES AND MEDICAL STATISTICS

TABLE 83
West Africa Command, 1941-45
Admissions to Hospitals, All Causes
Annual Rates per 1,000 Strngth

Source: West Africa Annual Statistical Reports, 1944, 1945

Whole Command
Year Gold Nigeria
Coast All Causes

Europeans

1941 1,737 968 1,620

1942 1,585 907 1,436

1943 1,432 1,186 1,157

1944 1,029 1,332 1,105

1945 812 794 760

Africans

TABLE 84

West Africa Command, 1944, 1945
Admissions to Hospitals Sor Certain Infectious Diseases
Annual Rates per 1,000 Strength

Source: West Africa Annual Statistical Reports, 1944, 1945

1944 1945
(a) (b) Ratio (c) (d) Ratio
Europeans | Africans | (a)~-(b) | Europeans | Africans | (c)=-(d)

Malaria i , 278°'0 45° 6-2 919 32°8 2:8
Venereal Diseases . 81-2* 386-0* o2 82-0 482°4 o-2
Bacillary Dysentery. 65°2 4°6 14°2 24°4 8-9 2:8
Amoebic Dysentery. 26°0 4°9 5°3 4°3 23 rg
Schistosomiasis ‘ 24°3 19°4 3 oz 6°9 _-
‘Jaundice’ . 72 3°5 2°1 6-4 3°4 19
Tuberculosis . a 2-7 2°6 a 2°9 7 "7
Pneumonia. 2 19 21°4 o'r 12 1§°7 ovr
Chickenpox . 2 _ 17°8 _ _ 9°72 _-
Tropical Ulcer ‘ _ 8-7 _ _ 48 _
Trypanosomiasis . _ 16 _ _ r2 _
Cerebro-Spinal Feve - 14 _ _ 13 _
Smallpox . 4 _ oz _ _ oz _
Enteric Fevers _ oz _ _ = _-

* This figure includes cases treated in units.

THE ARMY MEDICAL SERVICES 317

Table 85 summarises available information regarding DYSENTERY
among Europeans, the incidence of which fell, being initially (1941) 51

TABLE 85

West Africa Command, 1941-45
Admissions to Hospitals for Dysentery (all types), Europeans only
Annual Rates per 1,000 Strength
Ratios of Bacillary to Amoebic Dysentery, 1941, 1944

Source: West Africa Annual Statistical Reports, 1944, 1945

Year Gold Nigeria Sierra Gambia Whole
Coast Leone Command

1941 28 25 46 117 51
1942 21 45 85 53 7
1943 28 42 49 5I 42
1944 36 13 24 56 27
1945 51 1 23 33 29

Ratio of

Bacillary

to Amoebic,

1941, 1944 rit 4it 6:1 rit 2:1

and finally (1945) 29. The ratio of Bacillary to Amoebic Dysentery was
much higher in Sierra Leone being 6 to 1 as against a Command ratio
of 2 to 1.

The successful control of MALARIA among both classes of troops is
shown by the rates in Table 86. Among Europeans, the 1945 rate was

TABLE 86

West Africa Command, 1941-45
Admissions to Hospitals for Malaria
Comparative Rates (1941 = 100)

Source: West Africa Annual Statistical Reports, 1944, 1945

Europeans Africans
Year |—————_,______ |__——__—_-—
Gold Nigeria Sierra Gambia Whole Whole
Coast Leone Command | Command
1941 100°O 100°0 100°0 100°9O 100°0 100°0
1942 86-9 93°! 76-6 161°2 85-1 102°8
1943 46:0 81-9 37°6 73°0 49°4 59°2
1944 24°3 7O°7 6-9 26°4 31k 63°4
1945 74 24°6 6-2 44 10°3 46-4

one tenth that of 1941, while the African rate declined by more than
half during the period. The reduction was not so remarkable in Nigeria
until 1945 when the incidence fell to just over one third the previous
year’s rate.

The number of cases of BLACKWATER FEVER among Europeans
Per 1,000 cases of Malaria is given in Table 87 and shows a remarkable

318 CASUALTIES AND MEDICAL STATISTICS

TABLE 87

West Africa Command, 1941-45
Admissions to Hospitals
Number of cases of Blackwater Fever per 1,000 cases of Malaria
Europeans only

Source: West Africa Annual Statistical Reports, 1944, 1945
Year | Gold Coast Nigeria Sierra Leone Gambia ie ncls

mmand
1941 8-4 bo any 3°5 16-0 60
1942 13°0 23°0 570 8-0 13°0
1943 11-0 10°0 6-0 8-0 g°0
1944 1°5 o's _ _ 10
1945 _

decline throughout the Command. After a rise of over 100 per cent. in
1942 there was a rapid fall, and in 1945 there were no recorded cases.
Comparable figures for Africans are not available, but it is known that
the hospital admission rates for this disease among Africans was 0-4 per
1,000 troops for each of the years 1944 and 1945.

The figures for VENEREAL DISEASES (Tables 88 and 8g), include

TABLE 88
West Africa Command, 1941-45
Incidence of Venereal Diseases (all types)
Annual Rates per 1,000 Strength

Source: West Africa Annual Statistical Reports, 1944, 1945

Year Gold Coast Nigeria Sierra Gambia Whole
Leone Command
Europeans
1941 714 37°2 §2°2 23°5 51°6
1942 62°3 47°8 418 16°2 45°3
1943 64°8 105°9 39° 20°7 69°4
1944 68-6 110°2 46-4 21°9 81-2
1945 82°6 85-2 88-6 40°9 82-0

cases treated in all medical units. Apart from a fall in 1942 for
Europeans and 1943 for Africans, the incidence rose each year,
notably among Africans in Gambia where the 1945 rate was seven times
that of 1942. Striking features in Table 89 (1945 compared with 1944)

THE ARMY MEDICAL SERVICES 319

TABLE 89

West Africa Command, 1944-45
Incidence of Venereal Diseases
Relative Rates

Source: West Africa Annual Statistical Reports, 1944, 1945

are the rise in Syphilis and Chancroid among Africans and the rise and

fall in Gonorrhoea and Chancroid respectively among Europeans.
Table go exhibits the relative causes of Evacuation to the United

Kingdom of Europeans and that of Invaliding from the Army of

TABLE 90

West Africa Command, 1942-45
Medical Evacuations to the United Kingdom (Europeans)
and Invalidings (Africans)
Relative Rates

Source: West Africa Annual Statistical Reports, 1944, 1945

Europeans Africans
(Evacuation to the U.K.) (Invaliding)
CAUSES ——_,———_ ———
1943 1944 1945 1942 1943 1944 1945,
Chronic Malaria and
Blackwater Fever ss ~ | 224 Pears 5:8 + + t §
Nervous and Psychiatric
Disorders (a). < r 85 17°6 19°2 = = Irs 64
E.N.T. Diseases ‘ ‘ 6: 76 gs i t t 40
Accidents. . . . s 5:3 3 t $ 534
Tuberculosis a aes : : 3 49 6-8 6-8 1074 i
Amoebic Dysentery. =. | 1° 7-6 2-0 t F3 t
Venereal Diseases. : o 0:3 0-6 s7 $7 43 19°7
Yaws s ‘i ES * . - 25°2 25°r 43 73
Guinea Worm be = a) 5:9 ir 6-1
say Se = ise 2-3 2-4 48 s
uses 39°9 46-1 55°7 sat S40 ors sica
Totals °; . . « | 100-0 | 100-0 | 1000 | 100-0 | 100-0 | 100-0 | ro0-o

(8) There are no satisfactory records of African psychiatric cases invalided during 1942 and 1943.
Less than 0:2 per cent.

Less than o-s per cent.

‘Less than 1-0 per cent.

Not recorded.

320 CASUALTIES AND MEDICAL STATISTICS

Africans. Evacuation to the United Kingdom does not necessarily
imply invaliding from the Army, as individuals may be medically unfit
for service in West Africa but fit for service in temperate climates. It
does, however, represent wastage to the Army in West Africa as does the
invaliding of local troops. Invaliding among Africans for Tubercu-
losis was twice that of evacuation of Europeans, as may be expected from
the admission rates (Table 84). Nervous and Psychiatric Disorders, the
largest figure among Europeans, accounted for nearly 20 per cent. of the
evacuations.

Deaths due to disease (Table 92) among Europeans in 1945 were
20 per cent. of the annual average for the period 1941-44. None were

TABLE 91

West Africa Command, 1941-4.
Medical ascents to the United "Raneace (Europeans)
ind Invalidings (Africans)
Annual Rates per 1,000 Strength

Source: West Africa Annual Statistical Reports, 1944, 1945

Year Gold Nigeria Gambia Whole
Coast mmand

Europeans (Evacuations to the United nee

1941 53 3 76 96

1942 54 70

1943 % é3 55 59

1944 44 116 75 85

1945 55 58 62 59
Africans (Invalidings)

1942 59 51 25 25 4

1943 51 43 23 ar 37

1944 52 62 18 34

1945 95 140 27 3 100

attributable to the diseases shown in the table. One half of the deaths
among Europeans in 1941-44 were caused by Malaria and Blackwater
Fever as compared with just over 1 per cent. for Africans. The main

causes of deaths among Africans were Pneumococcal Infection and
Tuberculosis.

THE ARMY MEDICAL SERVICES 321

TABLE 92

West Africa Command, 1942-45
Relative Mortality Rates, 1941-44 and 1945

Source: West Africa Annual Statistical Reports, 1944, 1

1941-44 1945
CAUSES |__|
Africans

Blackwater Fever . 1°45
Malaria - i 1°12
Pneumonia _
Pneumococcal

Infections _ 17°07 _ 10°62
Staphylococcal

Infections 4°29 7°70 _ *
Neoplasms 3°68 4°46 _ 4°92
Infective Hepatitis. 3°07 6-42 _ °
Heat Exhaustion 2°46 0-98 _ bd
Nephritis 2°45 3°85 om *
Encephalitis 2°45 1-21 _- 0°56
Smallpox 1°84 1°66 _ bd
Tuberculosis 1°23 13°22 _ 16°20
Bacillary Dysentery 1°23 3°25 _- 4°02
Strep’
ene 1°23 2cr1 _ 6-59

Infections es _ 10°80 _ 5°47
Vitamin Deficiencies _ 0°83 —- .
Others 21°48 25°16 100°00 49°05

Totals 100°00 100°00 100°00 100-00

* Figures not available—included in ‘Others’.

CHAPTER VII

EAST AFRICA COMMAND

must result in a somewhat sketchy and incomplete chapter. The
tabulations which follow, therefore, can be of only limited value.

Very little data are available prior to 1944. The statistics for that year
have been obtained from the ‘East Africa Command Health Report,
1944’. The troops in the Command during that year were composed of
British, East Africans, Mauritians, Seychellois and others of Colonial
stock, with the local East Africans predominating. As the only reliable
statistics in the report were for ‘All Troops’ only, it is impossible to
evaluate the incidence of disease among, or make a comparison between,
the various classes of troops located in the Command.

East Africa Command was non-operational in 1944. Its chief réle was
the training of reinforcements for East African Units in the Middle
East and South East Asia Commands. The Command included Kenya,
Tanganyika, Nyasaland, British Somaliland, Northern Rhodesia,
Madagascar, Mauritius and the Seychelles, a vast area ranging from the
malarious coastal regions to sub-tropical highlands. It would have been
both interesting and instructive to have been able to compare the in-
cidence of diseases in the Mombassa area with that in the Nairobi dis-
trict, or Mauritius with Madagascar. Unfortunately, this is not possible.

The information derived from the report mentioned above is pre-
sented in Tables 93 and 94. There is no reason to doubt the accuracy of
the data included therein.

Apart from the 1944 Report, the only statistics available are con-
tained in Table 95. These figures relate to British Troops only for 1945
and were obtained from the Hollerith Section of the War Office. All
statistics relating to admissions to Hospitals received from the Hollerith
Section are based on Army Forms I.1220 received in the War Office.
The accuracy of these figures is subject to the limitations mentioned in
the introduction to the Army section of this Volume.

As Army Forms I.1220 for British Troops only were sent to the War
Office for coding and translation to punched cards, it is not possible to
obtain from the Hollerith Section any information regarding the other
classes of troops in the Command. A comparison of morbidity rates for
all troops for the years 1944 and 1945 cannot, therefore, be made.

The tabulations presented refer to Hospitalisation only and do not
include any data relating to low grade morbidity.

Table 93 shows the Annual Rates per 1,000 strength of admissions to

T= dearth of morbidity statistics from the East Africa Command

322

THE ARMY MEDICAL SERVICES 323

TABLE 93

East Africa Command, 1944
Causes of Admissions to and Deaths in Hospital

All Troops
Annual Rates per 1,000 Strength
Source: East Africa Command Annual Health Report, 1944
Annual Rates
CAUSES
Admissions Deaths
Dysentery < ‘ s A 29°16 o-2r

Enteric Group of Fevers | . ‘ : o-18 0:08
Influenza . - 4 S a 7 4°39 _
Infective Hepatitis 2 e 6 < si 3 7°18 0°23
Kala Azar . és 2 - bs 5 0°07 o'or

Malaria 7 2 5 - a 100°60 0°24
Cerebro-Spinal Meningitis 5 3 é 7 : 1°58 0°29
Pneumonia f e fe ‘i s 7 14°06 0°66
Relapsing Fever s . ‘ “6 . : 5°02 0°02
Schistosomiasis : A 4 - ry 4°81 0°02
Smallpox . s 5 ‘ & F; 1°67 o-or
Tuberculosis. 4 * S i 2°00 o'sr
Undulant Fever bs 3 ‘ . . 3 0°04 _
Venereal Diseases 3 . 3 . 3 160°18 o'13
Yaws , 3 fs A “ * 0°68 _
Deficiency Diseases . ’ ‘ 5 ‘ 0-16 o-or
Effects of Heat . 0°20 _
Nervous Diseases 7°99 or12
Diseases of the Heart | 0°83 or17
Other Diseases of the Circulatory ‘System 9°50 0:07
Inflammation of the Bronchi : A : 29°34 oor
Other Diseases of the Respiratory System :
Pharyngitis and Tonsillitis . ‘.

Enteritis and Diarrhoea 5
Other Diseases of the Digestive System.

Skin and I.A.T. (including Scabies) : .
Rheumatic Fever and Other Rheumatic Diseases .
Other Diseases of the bones and organs of movement
Diseases of the Eye .
Diseases of the Ear. a . z 5 ‘i
All Other Diseases. . 5 2

Total Diseases . . 7 . is

Injuries—E.A. Se a eo ee era
Injuries-—NEA. . 3 . . +.

Total Injuries. 89. 0. ww
Total Admissions|Deaths BR ast es

324 CASUALTIES AND MEDICAL STATISTICS
‘TABLE 94
East Africa Command, 1944

Admissions to and Deaths in Hospitals
Breakdown of Certain Diseases Shown in Table 93

Troops
Annual Rates per 1,000 Strength
Source: East Africa Command Health Report, 1944

DISEASES

Totals .

Totals .

Syphilis é
Other Forms

Totals .

hospitals of ALL TROoPSs, while Table 94 analyses certain disease
groups.

Due to the absence of major epidemics, the admission rates fell from
681 in 1943 to 601 in 1944. The average admission rate per day was
1-65 per 1,000 troops. The death rate during the year was 5-6 per 1,000
compared with 6-9 in 1943.

Admissions for VENEREAL DISEASES accounted for over one quarter
of the total admissions for diseases, the rate being 160 per 1,000 com-
pared with 164 in 1943. The 1944 Report stated ‘The V.D. rate is
approximately three times as great in Africans as in Europeans...
nearly 50 per cent. of all V.D. infections in Africans were contracted on
leave’.

The admission rate for MALARIA was just over one sixth of the
total for diseases. It increased from 91 per 1,000 in 1943 to 101 in 1944.
This increase was due to an unusually high number of admissions in the
coastal region. Elsewhere in the Command there was a reduction in
admissions compared with the previous year.

A decrease in the rate for DYSENTERY was reported for the years
1941 to 1944. Rates per 1,000 were 93 in 1941, 57 in 1942, 59 in 1943

THE ARMY MEDICAL SERVICES 325

and 29 in 1944. This decline was attributed to the improvement of
sanitary conditions in camps and more rigorous sanitary discipline.

Admissions for PNEUMONIA were 29 per 1,000 in 1943 and 14 in
1944. The drop is attributable to there being no marked seasonal in-
crease in 1944 as was experienced in 1943 when pneumonia reached
epidemic proportions during the cold season.

‘TABLE 95
East Africa Command, 1945
British Troops
Causes of Admission to Hospital
Annual Rates per 1,000 Strength

Source: Hollerith Tabulations

CAUSES Annual Rates
Common Cold . 3 < : : E é . 3°56
Dysentery . : : : 17°93
Enteric Fever Group i 0°36
Infective Hepatitis ‘ a Z é ‘ % . 3°56
Malaria a s s 3 4 5 2 53°44
Pneumonia ‘ A 7 ‘ : 2°49
‘Tuberculosis—Pulmonary : 0°36
puberealosts Other Types = Z fe A s 7 0°24
P.U.O. : 5 : ‘ s : 11°99
Amoebiasis . cf ‘ ‘S ‘ _ ° 4°16
Venereal Diseases
Gonorrhoea Q°14
Syphilis . 4°99
Soft Chancre 2°38
Other Types 3°33
Total V.D. 5 . 4 es 19°83
Other Infectious Diseases. ‘ p 3 : ‘ 3°33
Scabies e q 2 A 5 E $ . 0°83
Other Infestations e . . 7 5 . é 1°54
Diseases of the Nervous System. sj . . a 2°02
Mental Diseases:
Psychoses 5 0°48
Psychoneuroses 4°51
Other . 0°24
Total Mental Diseases i“ i 5°23
Diseases of the Eye i ‘ 3 2 2°26
Diseases of the Bar, Nowe, and Throat:
Otitis Media 1°90
Otitis Externa ” 1°66
Pharyngitis 4°04
Tonsillitis 16°39
Other Diseases 3°68
Total E.N.T. Diseases a : 27°67

326 CASUALTIES AND MEDICAL STATISTICS

TABLE 95 (contd.)

East Africa Command, 1945
British Troops
Causes of Admission to Hospital
Annual Rates per 1,000 Strength

Source: Hollerith Tabulations
CAUSES Annual Rates

Diseases of the Cardio-Vascular System . ,
Diseases of the Blood and Blood-! -forming Organs
Diseases of the Respiratory System .
Diseases of the Mouth, Teeth, and Gums

Diseases of the Digestive Syren:
Appendicitis B 4°28
Diarrhoea 1-90
Enteritis . 16°51
Gastritis and Dyspepsia 6°41
Hernia. 5 2°26
Peptic Ulcers 1°07
er Diseases 10°09
Total Diseases of the Digestive System . 42.52
Diseases of the Genito-Urinary System . 16°74
Diseases of the Musculo-Skeletal System 15°44
LA.T. 8-91
Diseases of the Skin (excluding Scabies and ILA. AT). 17°58
Effects of Heat . o-71
All Other Diseases 11°40
Total Diseases 290°12
Injuries . 24°94
Burns 0°48
Total Admissions 315°5S4

In 1943, there was an epidemic of CEREBRO-SPINAL MENINGITIS.
The peak was reached in July 1943, declined throughout 1944 and
by the end of the year, very few cases were reported. This epidemic
affected both the civil and military populations in the East African
Territories and the decline corresponded in both the populations. The
1944 rate was 1-6 per 1,000 as compared with 6-5 in 1943.

RELAPSING FEVER showed a steady increase throughout the year
from 2 per 1,000 in 1943 to 5 in 1944.

An epidemic of INFECTIVE HEPATITIS commenced early in 1944,
reached its peak during the middle of the year and then subsided. The
rate per 1,000 for the year was 7:18-7:07 in Africans and 8-64 in
Europeans.

Table 95 records the hospital admission rates for BRITISH
TROOPS only in 1945. No figures prior to 1945 for this class of per-
sonnel are available, except that the rate for INFECTIVE HEPATITIS was

THE ARMY MEDICAL SERVICES 327

TABLE 96

East Africa Command, 1916-18 and 1944
Admissions to Hospital for Certain Diseases
All Troops
Rates per 1,000 Strength

Sources: 1916-1 oHistory of the Great War—Medical Services, Statistical Volume.
1944—East Afri ica Command Health Report for 1944.

1916 1917 1918 1944
Dysentery . - 182:21 277°O1 80°28 29°16
Enteric Group 2 : S 2°91 2°45 1-68 0-18
Malaria 7 S 9039'°IT 1,422°84 559°09 100°60
Pneumonia 5 5 9°4! 32°60 49°30 14°06
Corcoran inal Fever 5 7 N.A. 5°82 1°83 1°58
Smallpox . + 7 N.A. N.A. 7°34 1°67

8-64 per 1,000. This was revealed in the Annual Report for 1944.
The 1945 rate for this disease was 3-56.

During the War of 1914-18, a campaign was conducted in East Africa.
In the last war, the réle of the troops stationed there was mainly that
of training. Figures for both wars, therefore, are not comparable, but
from the point of view of interest, Table 96 is included. This gives
figures for All Troops for certain diseases during the years 1916 to 1918
and 1944. The data for the War of 1914-18 are taken from the Volume of
the History of the Great War, Medical Services, Casualties and Medical
Statistics.

CHAPTER VIII

INDIA COMMAND

NDIA Command consisted, at the outbreak of war, of the Indian Army
[= thatportion of the British Army stationed in India. Bothcomprised

only Regular Soldiers; personnel of the British Army were posted to
India for a tour of five years, while personnel of the Indian Army sel-
don, if ever, left India. Officers of the Indian Army were predominantly
of British origin, but this was gradually receding with the Indianisation
of the Indian Army.

Shortly after the outbreak of war, both British and Indian Units were
sent overseas on active service. Recruiting on a volunteer basis of Indians
commenced and eventually India produced the largest volunteer Army
known in history. As the war progressed, so the proportion of Indian to
British Officers in the Indian Army increased considerably.

India became a vast training ground and it was not until after the
entry of Japan into the war in December 1941 that the position of both
British and Indian Troops in the Eastern Command rapidly became
operational. In April 1942, Eastern Command was renamed Eastern
Army. On November 1, 1943 it was partitioned into the Fourteenth
Army and Eastern Command, the former passing to the control of South
East Asia Command and the latter remaining within the Indian Com-
mand. In the figures which follow, those relating to Eastern Army for
the whole of the years 1942 and 1943 have been excluded from those of
India Command.

Figures for personnel serving in India with units based on S.E.A.C.
are not included in this section, neither are those for Indian personnel
serving in Middle East, Persia and Iraq, North Africa, Central
Mediterranean, etc.—these are presented with statistics relating to the
Command concerned. They do, however, include personnel serving in
these areas who might have been admitted to hospital while on leave
in India.

The statistics set forth in this section are derived from the Annual
Reports on the Health of the Army in India for the years 1939 to 1945.
These reports are based on monthly statistical returns rendered by
hospitals and can be accepted as substantially accurate. If the reports
suffer from deficiencies they are, (2) seasonal fluctuations except in a
few diseases are not given, (b) morbidity among Officers is not dealt with
in such detail as that among Other Ranks.

The morbidity rates for both British and Indian Armies in India, in
general, show an upward trend throughout the war years. Factors which
may have affected this are:

328

THE ARMY MEDICAL SERVICES 329

(i) The alteration in the composition of the Army due to the great
influx of recruits and the recall of reservists. Young soldiers are
much more susceptible than seasoned troops to many diseases,
especially under war conditions when overcrowding in barracks
and tented camps tends to become rife. A large proportion of the
British Army, consisting mainly of young soldiers, were serving
in India for the first time. DIARRHOEA and mild DYSENTERY is
common in new arrivals in India. MALARIA and SANDFLY FEVER
might be more likely to affect newcomers to endemic areas.

(ii) The decline in physical fitness due to a relaxation of the peace-
time standards of entry, and the tendency to retain in the Army, as
long as they could usefully perform duties of any kind, individuals
who, before the war, would have been invalided.

(iii) It seems probable that there had been a general lowering of resist-
ance to disease as a result of harder work, longer hours on duty,
less leave and more time spent on the plains in the hot weather.

(iv) During the war, the Army was composed mainly of men who
were unaccustomed to improvised systems of sanitation and
unaware of the necessity for the strict observance of the rules for
personal and environmental hygiene, which are so important
under semi-active conditions for the prevention of disease. The
majority of Officers were new to the Army and much less skilled
than the pre-war Regular Officers in the art of maintaining the
health of their men.

(v) There was a largeincrease inthe movementsof units, oftenthrough
malarious areas. This led to large numbers of men being exposed
to infection in transit.

(vi) Due to the rapid expansion of the Army, camps were often sited
outside cantonments in endemic areas. To these were added
camps for training in jungle warfare, often in intensely malarious
areas.

Table 97 shows the principal causes of admission to Hospitals of
Officers and Other Ranks of the British Army. The total rate per 1,000
for Officers rose from 436 in 1939 to a peak of 1,099 in 1942 and fell
to 767 in 1945. That for Other Ranks showed a similar rise and fall,
664 in 1939 to 863 in 1945, except that the peak (1,014) was in 1944, two
years later than that for Officers. In comparison, the rates during the
First World War were (Table 108) Officers 694 in 1915, rising to 1,344
in 1918 and Other Ranks 825 in 1915, rising to 1,030 in 1918. (The high
rates for 1918 were due largely to the INFLUENZA Epidemic.)

The admission rate for DENGUE FEVER in respect of Officers is
approximately twice that of B.O.Rs. and that of CATARRHAL JAUNDICE

330 CASUALTIES AND MEDICAL STATISTICS

from twice to nearly five times. Officers appear to be more prone to
DIARRHOEA and DYSENTERY than are Other Ranks. In comparing
rates, however, it must be remembered that the age constitution
of the Officer group is higher than the Other Rank group. It is
possible that some of the higher rate of admissions is accounted for by
this greater age. Conversely, the ratios for MALARIA as between Officers
and Other Ranks were approximately:

1939 1:15 IQ4O1:1°7 I94T 1:2 1942 1:13

IQ4Z 1:14 1944 1:17 1945 1:2

The figures for MALARIA show a steady increase from 1939 to
1944 with a dramatic fall in 1945 to roughly half the 1944 rates. Even so,
the 1945 rate is twice that of 1939. This trend is also observed in the
MALARIA rates for the Indian Army.

The admission rates for SANDFLY FEVER, over the years, show a
decrease on the whole, the 1943 rate (the latest available) for Officers
being one-half that for 1939, with the 1945 rate for Other Ranks slightly
over one sixth that of 1939.

The incidence of VENEREAL DISEASES increased steadily from 51-2
per 1,000 in 1939 to 79:8 per 1,000 in 1945. The figures for 1917
and 1918 were 52 and 62 respectively. Although the rate for Indian
Other Ranks increased by 500 per cent. (Table 111) their 1945 rate
was just over 50 per cent., the B.O.R. rate.

The rates for HEAT EXHAUSTION (B.O.Rs. only) show a rapid increase
from 1939 to 1942 (1-9 to 17°5 per 1,000), a fall to 4:6 in 1943 and
a rise in the subsequent two years to 10°5 in 1945. The reason is not
difficult to find. The great majority of those attacked were young, un-
acclimatised soldiers who had been in India only a short time. Accom-
modation was much below pre-war standards and the hot weather of
1942 was exceptionally severe. The rate for 1942 was the highest ever
recorded for British troops in India. That for 1943, although the best
of the war years was about double the average for pre-war years. Table
112 shows the incidence of admissions for and deaths from HEAT
STROKE and HEAT EXHAUSTION year by year from 1936 to 1945 while
Table 113 compares the admissions for B.O.Rs. with that for I.0.Rs.
The latter table indicates the comparativeracial immunity of the Indians.

Table 98 exhibits the principal causes of DEATHS among B.O.Rs.
Total deaths rise from 2-58 per 1,000 in 1939 to a peak of 5-39 in 1942,
falling to 2-29 in 1945. Deaths from DYSENTERY in 1942 were thirteen
times those in 1939, MALARIA, five times and EFFECTS OF HEAT, seven
times.

Table 99 shows the principal causes of INVALIDING to the United
Kingdom of British Other Ranks. It must be understood that not all
those invalided from India would be invalided from the Army; some

THE ARMY MEDICAL SERVICES 331

would be medically downgraded for service in temperate climates. The
main causes for invaliding were PULMONARY TUBERCULOSIS and MENTAL
and NERVOUS DISEASES. The total figures for invaliding fell from 1939
to 1941, and rose from 1942 to 1945 when the rate was 16 per 1,000
against 7 for 1939. The low rates in 1940 and 1941 were partly due to
the policy of retaining those whose recovery could be completed in India
and partly to the shipping situation.

Admissions, deaths and invalidings of Officers and Other Ranks for
quinquennial periods from 1910 to 1939 and year by year from 1939
to 1945 are given in Table roo. It is interesting to note that the peak
year of deaths for both Officers and Other Ranks was 1942 which was
also the peak year for Officer admissions, but the peak of admissions
for Other Ranks occurred two years later, in 1944.

The principal causes for ADMISSIONS to hospital of Officers and Other
Ranks of the Indian Army are given in Table 102. The peak year for
both Officers and Other Ranks was 1942, although the rates for the
latter in 1943 and 1944 were only slightly lower. Rates rose, in the case
of Officers, from 462 in 1939 to 709 in 1942 and fell to 487 in 1945 and,
in the case of Indian Other Ranks from 454 to 747, to 584. DIPHTHERIA
was practically non-existent among Other Ranks. The incidence of
DIARRHOEA increased yearly to 1942 and fell subsequently. This was
paralleled by DYSENTERY, as could be expected. The rates for MALARIA
rose considerably (118 in 1939 to 206 in 1942). In 1945 there was a
dramatic fall in the incidence, the figure being 76 as against 160 in 1944.
This decrease was similar to that experienced with British Other
Ranks. Table 114, which exhibits the MALARIA rates for B.O.Rs.
and I.0.Rs, for the years 1938 to 1945 shows that in 1938 the Indian
rate was twice that of the British. In 1941 and 1943 the rates were
almost identical, but in 1945 the Indian rate was less than 60 per cent.
that of the British. (In 1946 there was a further fall in the rates,
the figures then being B.O.Rs. 34-1 per 1,000 and I.0.Rs. 43-7 per
1,000.)

The great majority of admissions for MUMPS occurred among Gurkha
recruits. The incidence of SANDFLY FEVER among officers was from three
to five times that among I.0.Rs., whereas the rates between Officers and
Other Ranks of the British Army differed only slightly. Admissions
for SCABIES increased from 11-9 in 1939 to a peak of 33-2 in 1944.
Comparable B.O.R. figures are 2-2 in 1939 to 15:5 in 1942.

In spite of the lowering of standards for enlistment and the environ-
mental hazards resulting from war-time conditions in the Indian Army,
the rates for TUBERCULOSIS among Indian Other Ranks remained sur-
prisingly constant (from 2:2 in 1939 to 2:9 in 1942, 1944 and 1945).

As with British Other Ranks, admissions for VENEREAL DISEASES rose
considerably, from a peace-time rate of 8-1 in 1938 to 49°8 in 1943.

332 CASUALTIES AND MEDICAL STATISTICS

By 1945 the rate had decreased by 6 per 1,000 to 43-4. Table 111
compares the rates for B.O.Rs. and I.0.Rs.

Indians appear to be more prone to COMMON COLD than do Europeans,
admissions being approximately three times for 1.0.Rs. than B.O.Rs.

Table 103 shows the principal causes of DEATHS among I.O.Rs.
Until 1944, the chief cause of death by disease was PNEUMONIA. In 1944
and 1945, PULMONARY TUBERCULOSIS took pride of place. As might be
expected the peak year for deaths was the same as that for admissions,
1942, when the rate was 4-99 per thousand. By 1945 the rate was down
to nearly that for 1938, although the rate for admissions had increased
by fifty per cent. The total death rates for B.O.Rs. and I.O.Rs. through-
out the war years were very similar (Table 107).

The chief cause for Invaliding among I.0.Rs. (Table 104) was
PULMONARY TUBERCULOSIS in the initial war years, to be superseded in
1943 by MENTAL DISEASES. The rate for the latter rose from 0-48 in 1939
to 4°13 in 1945 while that for PULMONARY TUBERCULOSIS increased from
1-7 to 2-4 in 1943 decreasing to 1-8 in 1945. The peak years for Invalid-
ing were 1944 and 1945 when the rates were nearly 30 per 1,000. The
rates for B.O.Rs. compared favourably with those for I.O.Rs. being
approximately one half from 1940 onwards (Table 107).

Table 105 exhibits comparisons between Officers and Other Ranks
of the Indian Army in respect of Admissions, Invalidings and Deaths
for Quinquennial periods from 1925 to 1939 and annually from 1939
to 1945. A striking aspect of this table is the extremely low rate of
invaliding for officers during the period 1940 to 1944, being approxi-
mately one fifth of the rate for 1939 and one quarter of the rate for the
period 1935-39.

Table 115 compares the incidence of DYSENTERY and DIARRHOEA
between (a) Officers of the British Army and Officers of the Indian
Army and (b) Other Ranks of the British Army and Other Ranks of the
Indian Army for the years 1939 to 1945. This table suggests that
personnel of the British Army are more prone to these diseases than
personnel of the Indian Army.

Tables 116 to 119 relate to the WOMEN’S SERVICES in India, i.e.
members of the Queen Alexandra’s Imperial Military Nursing Service
and the Womens Auxiliary Corps (India). The table relating to apMIs-
SIONS shows a steady increase from 1939 to 1945 in respect of members
of the Nursing Service (440 in 1939 to 1,233 in 1945) whereas the peak
year for admissions of W.A.C.(I.) members was 1942. In 1945 the rate
for W.A.C.(I.) was half that for 1942. The DEATH rates do not show any
appreciable trend. In 1941 the number of Q.A.I.M.N.S. in India was
comparatively small and a slight increase in the actual number of
deaths would tend to show a higher proportionate rate per 1,000. This
probably occurred in 1941 when the rate for deaths was 10°13. INVALIDS

THE ARMY MEDICAL SERVICES 333

sent Home (Table 118) in respect of Q.A.I.M.N.S. shows a trend
similar to that of Officers of the British Army (Table 106) when the
peak was in 1943. Here again, invalids sent to the United Kingdom
would not necessarily be invalided from the Army on arrival, as opposed
to members of the W.A.C.(I.) which was composed of British and
Indian Women domiciled in India, the figures for whom are those
actually invalided from the Service.

Summary
Broadly speaking the major diseases in India during the war years
were:

(a) Among Europeans—Malaria, Venereal Diseases, Dysentery and
Diarrhoea.

(b) Among Indians —Malaria, Venereal Diseases, Respiratory
Diseases.

Perhaps the most outstanding feature revealed by the tables here
presented is that the striking reduction in 1945 of the number of
MALARIA cases. That this success in the prevention of this disease was
not transitory is emphasised by the figures for 1946 which show a
decline on the 1945 rates. The rate for B.O.Rs. in 1946 was 34°1 per
1,000 and that for I.0.Rs. 43-7. These rates were the lowest ever
recorded.

334 CASUALTIES AND MEDICAL STATISTICS

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336 CASUALTIES AND MEDICAL STATISTICS

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TABLE 99

India, 1939-45. British Army in India. Principal Causes of Invalidi:

Rates per 1,000

Source: Annual Reports on the Health of the Army in India

Total Invalids

Injuries—E.A.
N.A.—No Figures available.

HA AMEMONDOON AM

THE ARMY MEDICAL SERVICES 337

TABLE 100

India 1910-45
British Army in India
Comparative Table
Admissions, Deaths and Invalidings
British Officers and British Other Ranks for Quit
Periods from 1910 to 1939 and Year by Year from 1940 to 1945
Annual Rates per 1,000 Strength

‘Source: Annual Reports on the Health of the Army in India

1910-1914 5°14 4°36
1920-1924 6-71 5°24
1925-1929 5°25 2°90
1930-1934 6-69 2°64
1935-1939 pti as
1940 “9: :
1941 038 4°19
1942 7°43 5°39
1943 6°16 3°02
1944 5°36 3°33
1945 4°48 2°29

TABLE 101

India, 1935-45
British Army in India
British Officers and British Other Ranks
Average Constantly Sick in Hospital and Barracks
Annual Rates per 1,000 Strength

Sources: Annual Reports on the Health of the Army in India

Note: Figures for Officers treated as Out-Patients are not available.

TABLE 102
ia, 1938-45. Indian Army in Indi

I

Principal Causes of A

338 CASUALTIES AND MEDICAL STATISTICS

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Annual Rates per 1,000 Strength
Officers|

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‘Note: ‘The term ‘Officers’ relates to King’s Commissioned Officers. Viceroy's Commissioned Officers are included in ‘Other Ranks’,

not available. An:

N.A.—Fi

THE ARMY MEDICAL SERVICES 339

TABLE 103

India, 1938-45
Indian Army in India
Principal Causes of Deaths
Indian Other Ranks*
Annual Rates per 1,000 Strength

Source: Annual Reports on the Health of the Army in India

CAUSES 1938 1945
Diseases of the Circulatos System orrs oO" o
Diseases o! Digestive System . orn o o
Diseases of the Nervous System 0-08 ° Oo" oO o
Diseases of the Urinary System 0-04 | o- ms o or
Dyesentery 0°03 | O° o o on 0-02
Enteric Group of Fevers 0:07 | o- o o on 0°04
Malaria o-0s | o- Oo o oO ovr
Meningococcal Infection 0-07 | o o Oo o 0:04
0°43 | o- o- 0: o- 0:23
Mien anise Pulssncy 0-12 | oO o o o o°s4
Tuberculosis—Other Forms . oo o o 0°08 | 0-07
Injuries. y °- oO oo 0:60 | o-st
All Other Causes o o- 0°68 | 0-54
Totals a ro 3°30 | 2°62

° The term ‘Indian Other Ranks’ includes Viceroy’s Commissioned Officers.

TABLE 104

India, 1938-45
Indian Army in India
Principal Causes of Invaliding
Indian Other Ranks*
Annual Rates per 1,000 Strength

on the Health of the Army in India

Blood and Blood-t +28 | 0°78
mes, fous, Bogmng Ongena real
Oo ato | 2°15
Diseaver of the Circulatory S: o ° 0°99
Diseases of the Digestive S: ie’ O° Ha 1*20
Diseases of the Nervous System. oO 1-41 | 0°93
Diseases of the Ear and Nose oO 0°35 | 0°28 | o-g1 +66 | 2°03
Diseases of the Eye. : 0-38 9, 0-69 | 0-82 19 2:0;
Diseases of the Urinary System 0°07 | o-1 0°09 | O-13 ovr or
Malaria A rs PS 0°02 | 0°08 | 0-07 | 0-12 0-27 | 0°42
Mental Diseases | 0°48 | 0-81 | 0-77 | 1-15 aca | 4°13
Teeth and Gums 0°11 | 0°33 | 0-1 0-10 . 0°54
‘Tuberculosis —! 1°70 | 2-02 | 1-71 | 1°84 Sie rb
ater ie Other Forni a 0-21 38 Cae 0-25 0-28 | 0-27
Other Diseases o! Respiratory ystem 0°34 | o- 0-81 | 1-42 : 3°29
Venereal Diseases 0°04 | 0°12 | 0-03 | 0°06 3:20 0-07
Injuries. i "86 | 4:11
All Other Causes. 4°54 | 5°13

6-43 11°86 | 9°79 |12-28 |23-87 |29-93 |29°85

* The term ‘Indian Other Ranks’ includes}Viceroy’s Commissioned Officers.
12CMB

340 CASUALTIES AND MEDICAL STATISTICS

TABLE 105

India, 1925-45
Indian Army in India
Admissions to Hospital, Invalidings and Deaths
Officers and Indian Other Ranks*
Quinquennial Comparative Table for the period 1925-39 and
Annual Comparative Table Year by Year from 1939 to 1945
Annual Rates per 1,000 Strength

Source: Annual Re on the Health of the Army in India

Invalidings Deaths

Period —_——_——
1.0.Rs.
1925-29 ; 3°48
1930-34 5°37 2°63
1935-39 6-05 2°68
1939 3°85 2°12
1940 5°17 air
1941 3°48 3°48
1942 3°49 4°99
1943 2°65 4°12
1944 2°15 3°30
1945 2°57 2°62

* The term ‘Indian Other Ranks’ includes Viceroy’s Commissioned Officers.

TABLE 106

India, 1925-45
Army in India
Admissions to Hospital, Invalidings and Deaths
Officers, British Army and Officers, Indian Army*
Quinquennial Comparative Table for the period 1925-39 and
Annual Comparative Table Year by Year from 1939 to 1945
Annual Rates per 1,000 Strength

Sources: Annual on the Health of the Army in Indis

Officers*
Period

1925-29

* The term ‘Officers’ does not include Viceroy’s Commissioned Officers.

THE ARMY MEDICAL SERVICES 341

TABLE 107

India, 1925-45
Army in India
Admissions to Hospital, Invalidings and Deaths
British Other Ranks and Indian Other Ranks*
Quinquennial Comparative Table for the Period 1925-39 and
Annual Comparative Table Year by Year from 1939 to 1945
Annual Rates per 1,000 Strength

Source: Annual on the Health of the Army in India

Admissions
1925-29 2°90 3°48
1930-34 2°64 2°63
1935-39 2°54 2°68
1939 2B 2°12
1940 2°5) 2crr
1941 4719 3°48
1942 5°39 4°99
1943 3:02 4:12
1944 3°33 3°30
1945 2°29 2°62

* Includes Viceroy’s Commissioned Officers.

TABLE 108

India, 1940-45
British Army in India
Admissions to Hospitals
Comparison between Annual Rates per 1,000 Strength in the Years
I9I5 to 1918 with those in the Years 1940 to 1945

Source: Annual Reports on the Health of the Army in India

Indian Army Officers
Indian Army Other Ranks

342 CASUALTIES AND MEDICAL STATISTICS

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344 CASUALTIES AND MEDICAL STATISTICS

TABLE 112

India, 1936-45
British Army in India
Effects of Heat
British Other Ranks
Annual Rates per 1,000 Strength

on the Health of the Army in Indias

9Qnns 9000
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346 CASUALTIES AND MEDICAL STATISTICS

TABLE 114
India, 1938-45
Malaria
Comparison of British Other Ranks with Indian Other Ranks, 1938-45
Annual Rates per 1,000 Strength

Source: Annual Reports on the Health of the Army in India

1939 1940 | 1941 | 1942

164°1

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347

THE ARMY MEDICAL SERVICES

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348 CASUALTIES AND MEDICAL STATISTICS

TaBLe 116
India, 1939-45
Army in India
Women’s Services
Admissions to Hospital
Annual Rates per 1,000 Strength

rts on the Health of the Army in India

1939 1940 1941

Members of Q.A.I.M.
Nursing Service .

Women’s Auxiliary Corps
(india)

439°6 | $47°7 | 638-5 | 824-8

1,184°3

TABLE 117
India, 1939-45
Army in India
Women’s Services
Deaths in Hospitals
Annual Rates per 1,000 Strength

on the Health of the Army in India

1945

Members of Q.A.I.M.
Deas 1-64
Wwe A

Tasie 118

India, 1939-45
Army in India
Women’s Services
Invalids sent Home
Annual Rates per 1,000 Strength

on the Health of the Army in India

Members of Q.. ae M.
Nursing

‘Women’s Auxiliary Corps
(india) Rice es

TABLE 119
India, 1939-45
Army in India
Women’s Services
Average Constantly Sick
Annual Rates per 1,000 Strength

Source: Annual Reports on the Health of the Army in India

1939 | 1940 | 1941 | 1942 | 1943 | 1044 | 1045

Members of Q.A.I.M.
Nursing Service . . + | 18:57 | 22°26 | 20-24 | 32°64 | 35°30 | 44°04 | So°s8

‘Women’s Auxiliary Corps

(India) s 8-56 16°15 22°56 18-92

CHAPTER Ix

SOUTH EAST ASIA COMMAND

EDICAL Statistics for South East Asia Command (S.E.A.C.),

presented in this chapter, have been grouped according to the

two areas for which data are available, i.e. the Indo-Burma
Front and Ceylon. That this is possible is due to administrative con-
siderations and because of it, comparison can be made of the incidence
rates among troops of the same stock stationed in areas which differed
markedly, not only in geographical conditions, but also in the intensity
of operational activity.

The area in which troops on the Indo-Burma Front operated contains
some of the worst malaria spots in the world. Climatic conditions ranged
from the excessive heat of the plains and the humid coastal and jungle
areas, to the colder mountainous regions of the north. It was an area
which experienced intense, bitter fighting. In contrast, Ceylon enjoys
a more equable climate and enemy action consisted of occasional
bombing.

Although this section is designated ‘South East Asia Command’,
statistics herein include casualties sustained before the formation of the
Command. Tabulations for both areas have been compiled for the
years 1942 to 1945. In 1942 units in the Eastern Command of India
became fully operational and were divorced from the Army in India.
They became known as the Fourteenth Army, which was later incor-
porated into S.E.A.C. on the formation of that Command in 1943.
The tabulations of the Indo-Burma Front, therefore, contain statistics
of the Eastern Command, the Fourteenth Army and the Indo-Burma
Front of S.E.A.C. It is possible, too, that they contain some admissions
resulting from the Japanese invasion of Burma; they certainly do include
all known admissions to hospitals during the operations which resulted
in the re-occupation of that country.

The information contained in this section was obtained, originally,
from Army Form A.31-B. This was a monthly return devised to show,
inter alia, the numbers admitted to hospitals, by diseases and deaths in
hospitals. It was similar in form, though less detailed, to Army Form
A.31 used by hospitals in areas other than operational in India. Trans-
mission of this statistical information followed conventional lines, from
hospitals to A.Ds.M.S., to D.Ds.M.S., to D.M.S., S.E.A.C., and thence
to D.M.S., G.H.Q.(India). An interesting point in the transmission of
these medical statistics was that the D.M.S., S.E.A.C., was not empow-
ered, originally, to send such information direct to the War Office
and it was only towards the end of the campaign in this area that the

349

350 CASUALTIES AND MEDICAL STATISTICS

War Office obtained satisfactory detailed information direct from
S.E.A.C.

The statistics which follow relate to admissions direct to hospitals
from Units and transfers thereto from other medical units. They take
no account of those admissions to such other medical units as Field
Ambulances, Casualty Clearing Stations, Malaria Forward Treatment
Units, etc., which did not eventually result in transfers to hospitals.
Indeed, such information is not available.

A few words must be said with reference to Malaria Forward Treat-
ment Units, and the impact of admissions thereto on the statistics
which follow, particularly in relation to Malaria.

In 1942 and 1943, admissions to hospitals on account of Malaria
were nearly one half the total patients admitted for disease. Cases were
evacuated to hospitals sometimes well to the rear of active operations
and many were sent to convalescent camps still further away. For
various reasons, it was often a long, difficult, and tedious process to
effect a return to units after convalescence. There was thus a colossal
wastage of man-hours between discharge from hospital and return to
unit and a consequent diminution in fighting strength.

With the object of reducing this wastage and lightening the burden
admissions for Malaria had placed on General Hospitals, Malaria
Forward Treatment Units were formed. These were mobile units,
each of two hundred and fifty beds, which functioned in close proximity
to forward troops. They operated in 1944 and 1945. As, finally, there
were sixteen of these units functioning on the Indo-Burma Front,
admissions to them for Malaria must have been of a very high magnitude,
and the incidence rates for this disease in 1944 and, particularly, 1945,
shown in the following tabulations are, therefore, far from complete.
These units also treated patients suffering from minor diseases when the
bed situation allowed. These cases were comparatively few and would
have little effect on the incidence rates of such diseases shown in the
tabulations.

Apart from these considerations, there appears to be no reason to
doubt the accuracy of the statistics here presented.

Troops engaged on the Indo-Burma Front included those of British,
Indian, West African, and East African stock. Similar classes (except
West Africans) were stationed in Ceylon, where, in addition, there
were Ceylonese units. The statistics which follow have been arranged
according to these ethnic groups and, where the information is available,
sub-divided into Male Officers, Male Other Ranks, and Women’s
Services. In addition, and in accordance with long established con-
vention, statistics for Indian Other Ranks have been sub-divided into,
firstly, Viceroy’s Commissioned Officers and Indian Other Ranks
(V.C.Os. and I.0.Rs.) and, secondly, Non-Combatants (Enrolled)

THE ARMY MEDICAL SERVICES 351

(N.Cs.(E)). Tabulations relating to incidence rates for All Troops are
included for each of the geographical areas.

Attached to Indian, African and Ceylonese Units were British
Officers and Other Ranks of various Corps and Regiments of the
British and Indian Armies. Any admissions to hospitals in respect of
these personnel are included in the figures relating to British Officers
or British Other Ranks (B.O.Rs.). Similarly, admissions of any Indian,
African, or Ceylonese personnel attached to British or other units are
included in the statistics of their own ethnic group.

Injuries, as in other sections, have been grouped according to whether
they were received through enemy action (E.A.), or otherwise (N.E.A.).
For 1942 and 1943, no breakdown of N.E.A. injuries are available.
During 1944 and 1945 they were broken down as to ‘Burns and Scalds’
and ‘Other Injuries’. Sub-divisions of E.A. injuries were reported for
the four years under review as to Blast, Bomb wounds, Gunshot-
wounds, and Shell wounds. A tabulation has been prepared for each
area showing the sub-division of injuries, according to ethnic grouping,
together with the overall detail for All Troops.

In so far as deaths in hospitals are concerned, very little data are
available. The only information that can be presented is the annual
rates per 1,000 strength, classified ethnically, under two headings,
‘Diseases and N.E.A. Injuries’ and E.A. Injuries’. The rates quoted
relate to deaths in hospitals only. They do not include deaths on the
field of battle or in other types of medical units.

Finally, tabulations have been produced showing comparative rates
of diseases for each of the ethnic groups.

As in the majority of sections, the rates cited herein have been cal-
culated per 1,000 strength. It will be noted that in some tables Equivalent
Annual Rates (E.A.R.) have been computed. This is due firstly, to
East and West African Troops being in the Command for only a portion
of 1944 and, secondly, to data being available in some cases for nine
months only in 1945. Known admissions have been adjusted to equi-
valent annual rates in order that valid comparisons may be made with
the rates of other years.

In the ensuing examination of the tabulations the procedure followed
is to consider by each area, firstly, admissions for diseases only for each
class of troops. Following this statistics for injuries and then deaths
are considered. Finally, the medical ethnography of the areais examined.

The following tables for S.E.A.C. are presented:

352 CASUALTIES AND MEDICAL STATISTICS

Indo-Burma Front
Periods
CLASS OF TROOPS Covered Table No.
(i) Admissions for Diseases
British Officers. 2 a 1942-45 120 136
British Other Ranks . S - | 1942-45 121 137
Q.A.1.M.N.S. rs s - | 1942-45 122 _
All British Troops. ‘ - | 1942-45 123 138
Indian Officers i: ss ss 1942-44 _ 139
V.C.Os. and I.0.Rs. i « | 1942-45 124 140
N.Cs.(E.) 5 ‘ . s 1942-45 125 141
V.C.Os., I.0.Rs. and N.Cs.(E.) 1942-45 126 _
W.A.C. (I) and I.M.N.S. . - | 1942-45 127 142
All Indian Troops . A ‘ 1942-45 128 143
W.A.O.Rs. K 3 . . 1944-45 129 _
E.A.O.Rs. s ¥ i, - | 1944-45 130 144
Ceylonese Officers . A - | 1943-45 _ 145
Ceylonese Other Ranks. + | 1943-45 _ 146
All Ceylonese Troops : - | 1943-45 _ 147
All Troops ‘ : ‘3 : 1942-45 131 148
(ii) Admissions for Injuries .
All Troops > : & - | 1942-45 132 149
(iii) Deaths in Hospitals
All Troops 1942-45 133 150
(iv) Medical Ethnography
British and Indian O.Rs. . E 1942-45 134 151
British, Indian and Ceylonese
O.Rs. é 7 - - | 1943-45 i) 152
All Other Ranks 1944-45 135. 153

(x) Indo-Burma Front
BRITISH TROOPS

OFFICERS

Table 120 shows the causes of admissions to hospitals of British
Officers. The highest rate of admission for disease occurred in 1943,
when the figure was 726 per 1,000. In 1944 and 1945 admissions declined
somewhat spectacularly to 521 and 344 respectively, that is, in 1944 to
between one quarter and one third less, and in 1945, to slightly more
than half, the 1943 rate. Admissions in 1942 were slightly less than in
1943, at 714 per 1,000.

Injuries accounted for rates of 35 in 1942, 48 in 1943, 87 in 1944 and
73 in 1945.

The highest recorded rate of admissions from all causes was 774 per
1,000 in 1943, followed by 748 in 1942, 608 in 1944 and 417 in 1945.

THE ARMY MEDICAL SERVICES 353

During the first three years, of individual diseases, MALARIA accounted
for the highest rate of admissions. In 1942 admissions for this disease
were thirty-seven per cent. of the total for all diseases; in 1943 they
were thirty per cent.; in 1944, twenty-four per cent.; and finally, in
1945, fell to only nine per cent. To make a further comparison, in 1942
and 1943, the admission rates for Malaria were approximately three
times those for Dysentery, which caused the second highest rate c‘
admissions. In 1944 the rate was a little more than twice that of Dysen-
tery, in spite of a decline in the admission rate of the latter disease.
In 1945, admissions for Malaria dropped to second place, being four-
fifths the rate for Dysentery. The incidence rates for Malaria during
the years under review were: 262 per 1,000 in 1942, 221 in 1943, 124
in 1944 and only 30 in 1945 (See p.355).

DYSENTERY followed Malaria as next in importance from the point
of view of admissions. This disease recorded a steady decline throughout
the years from 82 per 1,000 in 1942 to 73 in 1943, 57 in 1944 and 38 in
1945.

The third highest rate of admissions was recorded by Other Diseases
of the DIGESTIVE SYSTEM. Here again a steady decline was experienced,
from 53 per 1,000 in 1942 to 48 in 1943, 30 in 1944 and 17 in 1945.

It is of interest to note that if the four annual rates of admission in
respect of Dysentery and Other Diseases of the Digestive System are
plotted, the resultant courses are almost parallel.

Admissions for DIARRHOEA, however, do not conform to this pattern.
The rate increased from 29 in 1942 to 36 in 1943 and again to 42 in
1944. There was a fifty per cent. decline in 1945 when the recorded
rate was 20.

P.U.O. and N.Y.D. FEVER followed a similar, though more spectacular
trend. The rate increased by fifty per cent. in 1943, and this was
followed by a sixty per cent. increase. In 1945, the rate, which declined
to forty per cent. of the 1944 rate, was very slightly less than that for
1942. Relevant rates were: 1942, 21 per 1,000, 31 in 1943, 50 in 1944
and 20 in 1945.

SEPTIC CONDITIONS were responsible for admissions at 35 per 1,000
in 1942 and 1943, followed by 20 in 1944 and 23 in 1945.

Admissions for INFECTIVE HEPATITIS were comparatively low in 1942,
at 10 per 1,000. In the two years which followed the rate increased
two and a half times to 25, and there was a slight fall to 23 in 1945.

Diseases of the skIN (other than Scabies) were responsible for
admissions at fairly stable rates during the first three years, at 15, 17
and 14 per 1,000 respectively. In 1945, however, the rate increased
somewhat markedly to 23.

Admissions for diseases of the EAR, NOSE and THROAT fluctuated
slightly from 11 per 1,000 in 1942 to 17 in 1943, 15 in 1944 and 12 in 1945.

354 CASUALTIES AND MEDICAL STATISTICS

In 1942 the rate of admissions for DENGUE FEVER was 26 per 1,000;
it fell to 20 in 1943, and again, to 4 in 1944. This latter rate was main-
tained in 1945.

Of the numerically minor causes of admission, those for MENTAL,
PSYCHONEUROTIC and PERSONALITY DISORDERS tended, on the whole, to
increase throughout the period. Admissions in 1942 were 5 per 1,000;
in 1945 they had more than doubled to 13. In the intervening years
they were 7 in 1943 and 5 in 1944. This tendency to increase is exhibited
in all classes of male troops on this front.

Admissions for TUBERCULOSIS, although comparatively few in number,
were fairly stable, apart from 1944 when the rate was remarkably low
at 0-12 as against 1-07 in 1942, 0-89 in 1943 and o-g1 in 1945.

The rates for DIPHTHERIA fluctuated from 0-21 in 1942 to a peak of
1°25 in 1943.

Admissions for PNEUMONIA in 1943 are not known. Apart from this
and although rates are low, they tended to increase. Relevant rates
were 0:64 in 1942, 0°75 in 1944 and 1:28 in 1945.

Of the recorded diseases, those due to disorders of NUTRITION
showed the lowest rates of admissions, there being none in the years
1942 to 1944 with 0-08 per 1,000 in 1945.

The next lowest was for Mumps, which recorded rates of 0-21 in
1942, 0°71 in 1943 and 0-45 in 1945. There were no admissions for
this disease in 1944.

OTHER RANKS

Table 121 lists the admission rates to hospitals of BRITISH OTHER RANKS.

As in the case of British Officers, the highest rate of admissions for
disease occurred in 1943, but, whereas the increase over 1942 for
officers was but slight (726 per 1,000 as against 714), admission of
other ranks in 1943 rose by seventy per cent. In the following year they
decreased by nearly one quarter, while in 1945 they were less than half
the peak year of 1943 and a quarter less than the 1942 rate. In 1942, the
disease rate was half as much again as that for officers; in 1943 and
1944 it was approximately two and a half times, and in 1945 two and a
quarter times the officer rate. The relevant figures are shown in the
table below.

Indo-Burma Front. Admissions for Disease.
Comparison of Rates between
(i) British Officers and (ii) British Other Ranks, 1942-45

1942

Rates per 1,000 Officers 714 726 344
Strength Other Ranks 1,021 1,746 780
Comparative Rates Officers 100 100 100
Officer Base Other Ranks 143 240 227

THE ARMY MEDICAL SERVICES 355

Of individual diseases, MALARIA was responsible for the highest rate
of admissions, they being, in the first three years, approximately one-
third and in 1945, about one-sixth of the total admissions for disease.
The rates of admission per 1,000 strength of both Officers and Other
Ranks together with comparative rates are given below.

Indo-Burma Front. Admissions for Malaria.
Comparison of Rates between
(i) British Officers and (ii) British Other Ranks, 1942-45

1942 | 1943 | 1944 | 1945

Rates per 1,000 Officers 262 221 124 30
Strength Other Ranks 335 628 406 128
Comparative Rates Officers 100 84 48 11
1942 Base Other Ranks 100 187 121 38
Comparative Rates Officers 100 100 100 100
Officer Base Other Ranks 128 284 327 426

Whereas the rates of admissions on account of Malaria for Officers
declined each year, those for Other Ranks show that the highest rate
recorded was in 1943, followed by 1944, 1942 and 1945. The lowest
rate reported for Officers (in 1945) was approximately one-ninth the
peak admission rate (in 1942). For Other Ranks the lowest rate, also
in 1945, was one-fifth of the highest recorded rate (in 1943). It would
seem that ‘Anti-Malaria Discipline’, the personal precautionary measures
to be taken to avoid this disease, was of a much higher order among
Officers than among Other Ranks.

DYSENTERY caused the next highest rate of admissions of Other
Ranks as in the case of Officers. The Officer rates declined each year,
but those for Other Ranks show the peak year to be 1943, with the
lowest rate in 1945 at one-half the 1943 rate. The trends follow the
patterns exhibited by both classes of personnel in respect of Malaria.
Rates of admission, with comparative rates, are indicated below.

Indo-Burma Front. Admissions for Dysentery.
Comparison of Rates between
(i) British Officers and (ii) British Other Ranks, 1942-45

Rates per 1,000 Officers 82 73 57 38
Strength Other Ranks 88 132 97 65
Comparative Rates Officers 100 89 Jo 46
1942 Base Other Ranks 100 150 110 74
Comparative Rates Officers 100 100 100 100
Officer Base Other Ranks 107 182 170 171

There was very little difference in the 1942 rates, but in the following
years admission rates of Other Ranks were approximately one and

356 CASUALTIES AND MEDICAL STATISTICS

three-quarters those of Officers. This, as in the case of Malaria, was
probably due to more rigid personal discipline among Officers. It is
possible that some of the admissions were due to the normal increase in
incidence noticed among new arrivals in India, when rates are higher
until they become acclimatised.

Next in numerical importance came VENEREAL DISEASES. The peak
admission rate occurred in 1943 when it was 158 per 1,000 strength.
For the other years under review, the rates were slightly less than one
half the 1943 rate at 72 in both 1942 and 1945 and 69 in 1944.

P.U.O. and N.Y.D. FEveR accounted for a large number of admissions,
particularly in 1944. Rates increased from 36 in 1942 to 82 in 1943,
reached the peak figure of 169 in 1944 and, in 1945, declined sharply to
just above the 1942 rate at 42 per 1,000 strength. This trend is similar
to, but more extensive than for Officers.

Admissions for DIARRHOEA showed a similar tendency, in that rates
increased from 1942 to a peak in 1944 with a sharp decline in 1945.
Relevant figures were 42 in 1942, 77 in 1943, 91 in 1944 and 35 in 1945.
This again is similar to the trend demonstrated for Officers.

Other Diseases of the DIGESTIVE system were responsible for a com-
paratively high rate of admissions as were Other Diseases of the
RESPIRATORY System. In both cases rates were higher for Other Ranks
than for Officers, particularly so in the case of Respiratory Diseases, for
whereas the rates for Digestive Diseases were from fifteen to one hun-
dred and six per cent. more than those for Officers, Respiratory
Diseases ranged from nearly three hundred to over five hundred per
cent. Relevant figures are given below.

Indo-Burma Front. Admissions for (i) Other Diseases of the Digestive System

and (ii) Other Diseases of the Respiratory System.
Comparison of Rates between British Officers and British Other Ranks, 1942-45

(i) Other Diseases of the Digestive System 1942 1943 1944 1945
Rates per 1,000 Officers 53 48 30 17
strength Other Ranks 61 87 53 35
Comparative Rates Officers 100 100 100 100
Officer Base Other Ranks 115 181 177 206
Comparative Rates Officers 100 or 57 32
1942 Base Other Ranks 100 143 87 57
(ii) Other Diseases of the Respiratory System
Rates per 1,000 Officers 14 18 1 9
strength Other Ranks 54 69 50 59
Comparative Rates Officers 100 100 100 100
Officer Base Other Ranks 386 382 455 656
Comparative Rates Officers 100 129 79 64

1942 Base Other Ranks 100 128 93 109

THE ARMY MEDICAL SERVICES 357

Diseases of the skIN (excluding Scabies) accounted for admissions
of the order of 42, 50, 36 and 51 per 1,000 during the four years,
while the rates for SCABIES were 8, 17, 13 and 5 respectively. The rates
for the former were between two and three times, while those for
Scabies were from two to sixteen times, the rates for Officers.

The trend of admissions for diseases of the EAR, NOSE and THROAT
among Other Ranks was similar to that of Officers. The rates were
approximately twice those of Officers and were 19 in 1942, 36 in 1943,
27 in 1944 and 26 in 1945.

SEPTIC CONDITIONS were responsible for admissions at a range of
rates from 21 to 36 per 1,000. Although the range was very similar to
that of Officers (20 to 35) rates for the latter were, on the average,
slightly higher than those for Other Ranks. These were 25 in 1942,
36 in 1943, 22 in 1944 and 21 in 1945.

The admission rates for INFECTIVE HEPATITIS in 1944 and 1945 were
over six times that in 1942. The rates, which were 5 per 1,000 in 1942,
27 in 1943 and 31 in 1944 and 1945 were higher than those for Officers.
In 1942 it was one half the rate; in 1943 it was slightly higher; in 1944
it was one quarter higher and in 1945 one third higher. Compared with
the 1942 rates, Officer admissions rose to a peak of two hundred and
fifty per cent. in 1943 and 1944 and fell slightly to two hundred and
thirty per cent. in 1945. Other Rank rates, on the other hand, were
over five hundred per cent. in 1943 and over six hundred per cent. in
1944 and 1945.

Admissions on account of DENGUE FEVER fell from 38 per 1,000 in
1942 to 25 in 1943. The following year there was a decline to 4, followed
by a further decline to 2 in 1945. This trend duplicated that of Officers.

The rates of admissions for COMMON COLD in respect of Other Ranks
were from two to three times those of Officers. Rates were 12 in 1942,
21 in 1943, 19 in 1944 and 17 in 1945. Those of Officers were 5, 8, 7
and 5 respectively.

MENTAL, PSYCHONEUROTIC and PERSONALITY DISORDERS were respon-
sible for an increasing rate of admissions from 2-5 in 1942 to 23 in 1945.
The comparison between the rates of Other Ranks and those of Officers
is interesting. In 1942 the Officer’s rate was twice that of Other Ranks.
By 1943 the rates were almost equal and in 1944 the Other Ranks rate
was twice that of the Officers. This was maintained in 1945. Taking
1942 as the base year, admissions of Officers had risen by 1945 two
and a half times, whereas Other Ranks admissions had risen over nine
times. It would appear that the increasing tempo of war in this area
affected British Other Ranks to a far greater degree than it did Officers.
Relevant figures are given below.

358 CASUALTIES AND MEDICAL STATISTICS

Indo-Burma Front. Admission Rates for Mental, Psychoneurotic and
Personality Disorders.
Comparison of Rates between (i) British Officers and (ii) British Other Ranks, 1942-45

Rates per 1,000 Officers 50

strength Other Ranks 2°5 23°2
Comparative Rates Officers 100 252
1942 Base Other Ranks 100 928
Comparative Rates Officers 100 100
Officer Base Other Ranks 50 184

Diseases of the EYE accounted for admissions of the order of 4-6 per
1,000 by 1942. In the following year, it had almost trebled to 13. In
1944 it fell to 10 but increased again to 13 in 1945. Officers’ rates were
lower at 6-5, 2:9, 2°6 and 5-4 respectively.

Apart from 1943, when the rate rose to g per 1,000, admissions for
Diseases of the CIRCULATORY System ranged between 5:4 and 5:8.
The rates for Officers were 6-7 in 1942, 5-7 in 1943, I°9 in 1944 and
3°1 in 1945.

The lowest recorded rate for individual diseases, as in the case of
Officers, was for Mumps. Recorded admissions ranged from 0-1 in 1942
to 0-5 in both 1943 and 1945.

Other diseases for which low rates were registered were those due to
Disorders of NUTRITION (ranging from 0-o to 0-8). SMALLPOX (0-4 to
1°01), TUBERCULOSIS (0-4 to 1-0), PNEUMONIA (0°9 to 1-2), DIPHTHERIA
(0-7 to 1-2) and the ENTERIC Group of Fevers (0-4 to 1-9). The majority
of these ranges are similar to those for Officers.

QUEEN ALEXANDRA’S IMPERIAL MILITARY NURSING SERVICE

Table 122 records the rates of admissions to hospitals of members of
the Q.A.I.M.N.S. In 1942, very few members of the Service were
located in the area. Comparisons of rates for that year with those of
other years when strengths were greatly increased is not satisfactory
and, although the rates for 1942 have been included in the table, they
are omitted from the discussion on morbidity. Similarly, because of
the low strength vis-a-vis British Officers and Other Ranks, a comparison
with the latter cannot be made, or conclusions drawn, with any degree
of validity.

Total admissions for Disease rose from 719 per 1,000 strength in
1943 to 869 in 1944 and fell to 389 in 1954. Three-quarters of thedecline
in 1945 is accounted for by the remarkable fall in the rates of Malaria,
Dysentery and Diarrhoea. These fell by 226, 96 and 44 respectively, a
total of 366 per 1,000.

THE ARMY MEDICAL SERVICES 359

There were no recorded admissions on account of injuries received
through enemy action for the three years under review. Those for
injuries not caused by enemy action were almost identical in 1943 and
1944 (43°8 and 43-6). In 1945 they dropped to less than half to 20-6.

The peak year of admissions for MALARIA was 1944. This differs
from the experience of male troops on this front, when the peak year
was 1943, but agrees with members of the W.A.C.(I) and I.M.N.S. The
rate in 1943, 87 per 1,000, increased to nearly three times that figure in
1944, when the rate was 229. In conforming to the trend exhibited by
all other classes in the Command, there was a remarkable reduction in
admissions during the following year when the rate was 23 per 1,000.

The rates for DYSENTERY and DIARRHOEA were also of a high order.
Those for Dysentery were 97 in 1943, 142 in 1944 and 45 in
1945. Admissions for Diarrhoea were somewhat lower at 59 in both
1943 and 1944 and 14 in 1945.

Admission rates for Other Diseases of the DIGESTIVE system
declined during 1944 and 1945 from 41 in 1943 to 33 in 1944 and finally
to 21 in 1945.

A similar decline was also in evidence for TONSILLITIS and SEPTIC
CONDITIONS, the rates being:

Tonsillitis 44 in 1943-26 in 1944 19 in 1945
Septic Conditions 31 in 1943 22 in 1944 To in 1945

Diseases of the EAR, NOSE and THROAT accounted for admissions of the
order of 25 in 1943, 26 in 1944 and 10 in 1945. The rates for Other
Diseases of the RESPIRATORY SYSTEM were of a comparatively high order
at 44 in 1943 and 37 in 1944 and 1945. Admissions for DENGUE FEVER
were also comparatively high in 1943 and 1944 at 25 and 31. There was
a marked decline in 1945 when the rate was 8 per 1,000.

The trend of admissions for MENTAL, PSYCHONEUROTIC and PER-
SONALITY Disorders is interesting in that the rates fell in 1944 and 1945.
This is at variance with the male Troops in the Command, but agrees
with the experience of members of the W.A.C.(I) and I.M.N.S.
Relevant rates of Q.A.I.M.N.S. admissions were 6-3 in 1943, 2°2 in
1944 and 2-1 in 1945.

There were no recorded cases of the ENTERIC Group of Fevers,
SANDFLY FEVER, SMALLPOX or VENEREAL DISEASES during the three years
under review.

ALL BRITISH TROOPS

In Table 123 are presented the annual admission rates per 1,000
strength of all British Troops. As the strength of Other Ranks was
many times the combined strength of Officers and members of the

360 CASUALTIES AND MEDICAL STATISTICS

Q.A.I.M.N.S., the trends of admission tend to follow, on the whole,
those of B.O.Rs. (Table 121).

The rates given in this table are in many cases slightly lower than
those for B.O.Rs. This is due to the rate of admissions for the two other
elements being somewhat less. Admissions for some diseases, however,
are higher, where the combined rate of admissions for Officers and
Q.A.I.M.N.S. were greatly in excess of those for B.O.Rs. This is ex-
emplified in Hepatitis, the Enteric Group of Fevers, Septic Conditions
and, in 1943, Mental, Psychoneurotic and Personality Disorders.

INDIAN TROOPS

Data are available, and tabulations presented, for Indian Troops in
respect of the following classes:

(i) Viceroy’s Commissioned Officers and Indian Other Ranks
(V.C.Os, and I.0.Rs.).

(ii) Non-Combatants (Enrolled)—(N.Cs.(E)).

(iii) Members of the Women’s Auxiliary Corps (India) and those of
the Indian Military Nursing Service (W.A.C.(I.) and I.M.N.S.).
Satisfactory records are not available to produce a separate tabulation
for Indian Officers, but such as are available have been included in the
statistics for all Indian Troops. The number of Indians commissioned
in the Indian Army was comparatively few, particularly in the first two
years reviewed here. Any deficiencies of records would, therefore, de-
tract little from the value of the figures presented.

It may be mentioned, as a matter of interest, that Viceroy’s Com-
missioned Officers were peculiar to the Indian Army and were analogous
to Warrant Officers in the British Army. Non-Combatants (Enrolled),
also peculiar to the Indian Army, and formerly known as Followers,
were recruited to undertake menial tasks in the Indian and British
Armies. Morbidity statistics of those N.Cs.(E.) and of any V.C.Os. and
1.0.Rs. who were attached to the British Army are included in the
tabulations which follow.

The Women’s Auxiliary Corps (India) was formed in the early years
of the war and was comparable with the A.T.S. in the United Kingdom.
Members consisted of women chiefly of European, Indian and Anglo-
Indian stock. The Indian Military Nursing Service, formed for service
in hospitals catering for Indian Troops consisted of women of similar
stock as the W.A.C.(I.).

v.C.OS. AND I.O.RS.

Table 124 shows the rates of admissions for V.C.Os. and I.0.Rs. for
the years 1942 to 1945. Admissions for diseases rose only in 1943 from

THE ARMY MEDICAL SERVICES 361

877 per 1,000 strength in 1942 to 1,073 in 1943. This was followed by
a decline to 912 in the following year, and in 1945 the rate was reduced
by approximately fifty per cent. to 466. Admissions on account of
injuries increased annually from 43 in 1942 to 56, 93 and 1o2 in the
succeeding three years. Total admission rates were 921 in 1942, 1,129 in
1943, 1,004 in 1944 and 568 in 1945.

As with other classes of troops in this Command, MALARIA, among
individual diseases, was responsible for the largestnumber of admissions.
In 1942 and 1943 the recorded admissions were approximately one-
half of those for all diseases and in 1944 it was roughly one-third. Actual
rates in these years were 447, 486 and 319. In 1945 there was a dramatic
decline of admissions and the rate fell to 68 per 1,000 or one-seventh
the total disease rate for that year.

Next in numerical importance to Malaria was P.U.O. and N.Y.D.
FEVER, admissions for which rose from 30 in 1942 to 72 in 1943 and 115
in 1944. The rate declined considerably in 1945 to 28. The importance
of the impact on admissions of Malaria and P.U.O. and N.Y.D. Fever
may be measured by eliminating the rates of these diseases from the
total disease rates as under.

Indo-Burma Front. Admissions ior (i) All Diseases and (ii) Malaria and P.U.O. and
N.Y.D. Fever, 1942-45.
V.C.Os. and I.0.Rs.

Admissions for: 1942 1943 1944 1945

(i) All Diseases. A ; 877 1,073 912 466
(ti) Malaria - | 447 486 319 68
(iii) P.U.O. and N.Y.D. Fever . 30 477] 72 558 | 115 434 28 96

(i) less (ii) and (iii) ‘ fy 400 515 478 370

The range of Malaria and P.U.O. and N.Y.D. was 462 (558 less 96).
That for the balance of diseases was 145 (515 less 370). The compara-
tively low range of the balance of diseases indicates:

(a) a fairly stable rate of admissions or

(b) erratic rates of admissions of individual diseases, high rises in some

being compensated by equivalent falls in others.
An examination of Table 124 reveals the latter was not the case.

Admissions for VENEREAL DISEASES were high with rates of 39 in 1942,
66 in 1943, 36 in 1944 and 46 in 1945.

DYSENTERY was responsible for a high rate in 1942 at 53 per 1,000. In
the following year the rate declined to 34 but rose again in 1944 to 40.
There was a marked fall in 1945 when the rate was only 19 per 1,000.
This rate compares satisfactorily with 14 per 1,000 recorded for
V.C.Os, and I.0.Rs. in India during 1945 and the pre-war Indian rate
of 17 per 1,000 (in 1938 and 1939).

362 CASUALTIES AND MEDICAL STATISTICS

Next in importance were admissions for SEPTIC CONDITIONS which
recorded rates of 28 in 1942, 40 in 1943, 30 in 1944 and 29 in 1945.

Admissions for other diseases of the DIGESTIVE SYSTEM increased
annually to 1944 and then fell to a rate only slightly above that for 1942.
Relevant figures were 22 in 1942, followed by 35, 37, and, finally, 23 in
1945.

DIARRHOEA caused admission rates at 28 in 1942 and 1943. In 1944
they rose to 40 per 1,000 but fell in 1945 to 18. The latter rate is slightly
higher (by 1-4 per 1,000) than the Indian rate for this class of troops in
1945. This disease did not parallel the experience of Dysentery which
recorded a rate in 1945 lower than the Indian rates for 1938 and 1939.
Indeed the rates for Diarrhoea in India for these years were at 5 and 6
respectively, one-third of the Indo-Burma Front rates.

Comparatively high in the order of admissions were those for coM-
MON COLD. These showed an increase of over one hundred per cent. in
1943, from 15 to 35. This was followed by a slight decline to 33 in 1944
and a steeper one in the following year to 24.

Among the diseases of smaller numerical importance, progressively
increasing annual rates were experienced by MENTAL, PSYCHONEUROTIC
and PERSONALITY DISORDERS. The low 1942 rate of 1°5 per 1,000 was
succeeded by 2-9 in 1943, 4°6 in 1944 and 7-33 in 1945. This trend was
not peculiar to V.C.Os. and I.O.Rs. Indeed, it was prevalent among all
male troops on the Front.

The rates of admission for TUBERCULOSIS were slightly lower than
those in India. This was probably due to a strict medical examination of
all personnel before being posted to units on active service, in order to
exclude the less fit, who were sent to units on garrison duty in India.
Relevant rates were 2:1 in 1942, followed by 1-4 in 1943, 1°3 in 1944
and 1°8 in 1945.

INFECTIVE HEPATITIS showed a startling increase in rates from 0-5
in 1942 to 147 in 1945. This indicates that for every person admitted
for this disease in 1942, twenty-nine were admitted in 1945. The rates
for the intermediate years were 2 in 1943 and 12 in 1944.

The rates for PNEUMONIA varied only slightly from 3-5 in 1942 to
2:3 in 1944 and 3°7 in 1945. The 1943 rate is not ascertainable. Very
slight changes were also recorded in the rates for TONSILLITIS, which
varied from 3 in 1942 and 1944, to 3-4 in 1945 and 3-5 in 1943.

Admissions for mMuMPs were less than those for the same class of
troops in India. Whereas the rates recorded on the Indo-Burma Front
were 11, 4, 5 and 6 respectively for the years 1942 to 1945, those in
India were 16, 15, 13 and 12.

SANDFLY and DENGUE FEVERS caused comparatively few admissions.
The rates for the former were 0-1, 0-3, 0:1 and 0-7, while those for the
latter were 2-5, 0:4, 0-4 and 1-2.

THE ARMY MEDICAL SERVICES 363

N.CS8.(E.)

Table 125 relates to the admissions to hospitals of Non-Combatants
(Enrolled).

The total admissions on account of disease only followed the pattern
of B.O.Rs. and V.C.Os. and I.O.Rs., in that there occurred a con-
spicuous rise in 1943 with successive falls in the two following years.
Relevant rates were 776 in 1942, 1,083 in 1943, 743 in 1944 and 279 in
1945.

Admissions for Injuries were fairly constant, being 34 in 1942,
followed by 38, 35 and, finally, 29 in 1945.

Total admission rates were 811 in 1942, 1,121 in 1943, 776 in 1944
and 308 in 1945.

In the following discussion on disease admission rates, comparisons
are made between those for N.Cs.(E.) and those for V.C.Os. and 1.0.Rs.
(Table 126), hereinafter called I.0.Rs.

Table 126 shows the average rates of admissions for the four years,
1942 to 1945, in respect of I.O.Rs. on the one hand and N.Cs.(E.) on the
other, and the order of numerical precedence from the point of view of
admissions.

The average rates for 1.0.Rs. were generally higher than those for
N.Cs.(E.). In only six diseases did the reverse hold good. These were
Venereal Diseases, Other Conditions of the Respiratory System, Mumps,
Pneumonia, Smallpox and the Enteric Group of Fevers.

A study of the ranking positions reveals the following:

Diseases with similar } Malaria, Common Cold, Diseases of the Skin

ranking positions (other than Scabies), Diseases of the Eye,
Tuberculosis, Enteric Group of Fevers and

Diphtheria.
Diseases with a P.U.O. and N.Y.D. Fever, Venereal Diseases,
divergence of one Dysentery, Other Diseases of the Digestive
position Systems, Scabies, E.N.T., Infective Hepati-

tis, Mumps, Mental, Psychoneurotic and

Personality Disorders, Tonsillitis, Dengue

Fever, Smallpox, Sandfly Fever, Disorders

of Nutrition, Septic Conditions.

Diseases with a
divergence of two ‘Diarrhoea, Diseases of the Circulatory System.
positions

Diseases with a
divergence of three +Pneumonia.
positions i

Diseases with a
divergence of more >Other Diseases of the Respiratory System.
than three positions )

364 CASUALTIES AND MEDICAL STATISTICS

Admissions for Diseases for each year except in 1943 were lower than
those for I.0.Rs. by 100 to nearly 200 per 1,000. In 1943 admissions of
N.Cs.(E.) exceeded those of I.0.Rs. by only 9 per 1,000.

As with other classes of troops, MALARIA caused the greater number of
admissions to hospitals. They followed the general pattern on this front
with an increase in 1943, a fall in 1944 and a larger one in 1945. Com-
parison of rates with those for I.0.Rs. reveals only small differences
except in 1942 when the rate for I.0.Rs. was one third higher than that
for N.Cs.(E.). Relevant rates, with those of I.0.Rs. in brackets were:
in in 335 (447), in 1943, 469 (486), in 1944, 278 (319) and in 1945,
37 (08).

The trend of admissions for P.U.O. and N.Y.D. Fever followed that
of B.O.Rs. and I.0.Rs. in that increases were experienced in 1943 and
1944 followed by a fall in the following year. The rates were 22 in 1942,
63 in 1943, 85 in 1944 and 20 in 1945. These were lower than those
recorded for I.0.Rs. which were 30, 72, 115 and 28 respectively.

A somewhat different tendency was exhibited in the case of VEN-
EREAL DISEASES. In 1942 and 1943 the rates among N.Cs.(E.) were higher
than those recorded for I.0.Rs. by slightly over 20 per 1,000. In 1944,
the rate was only 2 per 1,000 higher, but in 1945 admissions of I.0.Rs.
exceeded those of N.Cs.(E.) by 14 per 1,000. The recorded rates were:

Indo-Burma Front. Admissions for Venereal Diseases among
(i) V.C.Os. and I.O.Rs. and (ii) N.Cs.(E.), 1942-45.

1942 1945

(i) V.C.Os. and I.O.Rs. 4 39°2 46-0
(li) N.Cs(E.). 2 . 62°4 3r°s
Differences. . * « | #23°2 —14°5

Other Diseases of the RESPIRATORY SYSTEM also accounted for
admissions at higher rates except in 1945. In 1943 and 1944 the rate
was one third higher than I.0.Rs., but in 1945 admissions declined by
over one-half to a rate which was two-thirds that of I.0.Rs. Rates for
the two classes are as follows:

Indo-Burma Front. Admissions for Other Diseases of the Respiratory System among
(i) V.C.Os. and I.O.Rs. and (ii) N.Cs.(E.), 1942-45.

(i) V.C.Os. and I.0.Rs.

(ai) N.Cs.(E.) 14°8

Differences

Admissions for DySENTERY showed a downward trend during the
four years, the 1945 rate being only one quarter of that for 1942.

THE ARMY MEDICAL SERVICES 365

Rates were 40 in 1942, 35 in 1943, 28 in 1944, and 10 in 1945. These,
generally, were lower than those for I.0.Rs., the rates for whom were
53» 34, 40 and 19 respectively.

In 1943, the admission rate for SEPTIC CONDITIONS was the same
(28 per 1,000) as that for 1.0.Rs. In the succeeding three years, how-
ever, the difference in rates progressively increased in favour of
N.Cs.(E.) until the difference in 1945 was 13 per 1,000. Recorded rates
were:

Indo-Burma Front. Admissions for Septic Conditions among
(i) V.C.Os. and I.O.Rs. and (ii) N.Cs.(E.), 1942-45.

(i) V.C.Os. and LORS. . : 28-0 39°6 30°3 29°5
(ii) N.Cs.(E.) c 7 28-0 36-2 23°2 16-3
Differences. 5 ‘ ! NIL - 34 - 771 —13°2

The rates for Other Diseases of the DIGESTIVE SYSTEM were lower
than those for I.O.Rs. in 1942, 1944 and 1945, but higher in 1943.
They were 18 in 1942, 38 in 1943, 29 in 1944 and 12 in 1945 while
1.0.Rs. rates were 22, 35, 37 and 23 respectively.

COMMON COLD caused admissions in 1942 and 1943 at rates equi-
valent to those for I.O.Rs. at 15 and 34 per 1,000 respectively. In 1944,
the rate at 29 was 4 per 1,000 less and in 1945 the rate of 15 was 8-5 less
than for I.0.Rs.

As in the case of Dysentery, admissions for DIARRHOEA were lower
than those for I.0.Rs. at 18 per 1,000 in 1942 as compared with 28,
29 in 1943 (28), 21 in 1944 (40) and g in 1945 (18).

The rates of admissions on account of Diseases of the skIN and for
SCABIES among the two classes of troops are given below. Except for
1942 when the difference in rates was but slight, admissions were
higher among I.0.Rs. In both cases the rates for N.Cs.(E.) in 1945
were half those of I.0.Rs. There was very little difference in the rates
among I.O.Rs. for diseases of the Skin in the three years 1943-45,
but admissions of N.Cs.(E.) in 1945 were slightly over one quarter the
rate for 1943 whereas among I.O.Rs. it was just under one half.

Indo-Burma Front. Admissions for
(a) Diseases of the Skin (other than Scabies) and (b) Scabies among
(i) V.C.Os. and I.O.Rs. and (ii) N.Cs.(E.), 1942-45.

(a) Diseases of the Skin tober than Beabies)

-C.Os. and I.0.Rs. 12°4 25°4 26°7 23°8
N.Cs.(E.) < : : : 13°5 20°9 17°6 11-7

(b) Scabies
V.C.Os. and I.0.Rs. ‘ * . 15°9 27°6 23°4 12°6
N.Cs.(E.) * 5 , . a 16°9 24°4 14°4 6°5

366 CASUALTIES AND MEDICAL STATISTICS

Diseases of the EAR, NOSE and THROAT were responsible for a slightly
higher admission rate in 1942 as compared with I.O.Rs. In 1943 and
1944 the rates were approximately equal, but in 1945 the N.Cs.(E.)
rate was less than one half that of I.0.Rs. The rates were 18 in 1942,
20 in 1943, 18 in 1944 and 6 in 1945 as compared with the I.0.Rs. rates
of 15, 19, 18 and 14 respectively.

Similar trends were exhibited by both classes of troops with regard
to Diseases of the EYE, in that an increase of admissions in 1943 was
followed by a decline. Admissions of N.Cs.(E.) were less than 1.0.Rs.
by slightly over 1 per 1,000 in 1942 and 1943, followed by 4 in 1944 and
6 in 1945. Rates were 10, 18, 10 and 8 respectively.

Of the few diseases admissions for which increased over the years,
INFECTIVE HEPATITIS was, perhaps, the most striking. Although not,
numerically, very impressive, extensive increases were experienced by
both N.Cs.(E.) and I.0.Rs. In the case of the former rates were 0-1
per 1,000 in 1942 and 1943. This was followed by a dramatic rise to
10-2 in 1944 and 7-9 in 1945. Rates for I.0.Rs. were 0°5, 2-1, 12°3 and
14°7 respectively.

The trend of admission of N.Cs.(E.) for Mumps differed somewhat
from that of I.0.Rs. Whereas with the latter a peak rate in 1942 was
followed by two comparatively low rates, with a fifty per cent. increase
in 1945, the peak year for N.Cs.(E.) occurred in 1943, followed by two
successive falls. Relevant rates were:

Indo-Burma Front. Admissions for Mumps among
(i) V.C.Os. and I.0.Rs. and (ii) N.Cs.(E.), 1942-45.

(i) V.C.Os. and 2-0 .Re:
(ii) N.Cs.(E.) :

Admission rates for MENTAL, PSYCHONEUROTIC and PERSONALITY
Disorders were generally lower than those of I.0.Rs. but, like the
latter, registered progressive increases. In both classes, the 1945 rate
was approximately five times that for 1942. Rates are as follows:

Indo-Burma Front. Admissions for Mental, Psychoneurotic and Personality Disorders
among (i) V.C.Os. and I.O.Rs. and (ii) N.Cs.(E.), 1942-45.

(i) V.C.Os. end tO Re:
(it) N.Cs.(E.) .

Diseases of the CIRCULATORY sYSTEM among N.Cs.(E.) showed
satisfactory successive annual declines from 5-1 per 1,000 in 1942, to

THE ARMY MEDICAL SERVICES 367

4°5 in 1943, 3°3 in 1944 and, finally, 1-33 in 1945. Among I.0.Rs.
rates were at 5 per 1,000 for the first three years and 3 in 1945.

N.Cs.(E.) suffered slightly more admissions on account of PNEUMONIA
than did I.0.Rs. Rates for the former were 49 in 1942, 4°3 in 1944
and 4 in 1945. Those for I.0.Rs. were 3-5 in 1942, 2°3 in 1944 and
3°7 in 1945. The rates for 1943 are not available.

There was very little variation in the admission rates for TUBER-
cULosIS, which ranged from 2:0 in 1942 to 1°1 in 1944. (The 1943 and
1945 rates were 1-7 and 1-2 respectively.) These rates were very similar
to those recorded for I.0.Rs.

Diseases which caused admission rates of less than 1 per 1,000
strength were:

Diphtheria, the Enteric Group of Fevers,
Smallpox, Sandfly Fever, and those due to disorders of
Nutrition.

In all these cases there was very little difference in rates among

N.Cs.(E.) and I.0.Rs.

W.A.C.(I.) and I.M.N.S.

Table 127 relates to admissions to hospitals of members of the
Women’s Auxiliary Corps (India) and those of the Indian Military
Nursing Service.

The number of females attached to units in this area was com-
paratively few, particularly so in 1942 and 1943. Caution must be
exercised, therefore, when considering the rates and comparing them
with those of male troops. Because of the very small strength in 1942
and 1943 it would be unwise to compare rates of those years with
rates of the following years. In view of this, rates for the years 1944 and
1945 only are here discussed.

The table shows there were no admissions for DIPHTHERIA, SANDFLY
FEVER, SCABIES, SMALLPOX or Diseases due to DISORDERS Of NUTRITION
in 1944 or 1945. In 1944 there were no admissions due to PNEUMONIA
and, in 1945, none on account of DIARRHOEA, DENGUE FEVER, the ENTERIC
Group of Fevers, MUMPS, TUBERCULOSIS, Diseases of the CIRCULATORY
SYSTEM or to those of the EAR, NOSE and THROAT.

Diseases for which the admission rates were lower in 1945 than in
the previous year were:

MALARIA which fell from 135 to 28, a fall of 79 per cent.
Other Diseases of the

DIGESTIVE System which fell from 66 to 28, a fall of 58 per cent.
DYSENTERY which fell from 49 to 38, a fall of 23 per cent.
Other Diseases of the

RESPIRATORY System which fell from 32 to 23, a fall of 28 per cent.
INFECTIVE HEPATITIS which fell from 9 to 5, a fall of 44 per cent.

368 CASUALTIES AND MEDICAL STATISTICS

MENTAL PSYCHIATRIC
and PERSONALITY
DISORDERS which fell from 9 to 5, a fall of 44 per cent.
Diseases of the EYE which fell from 6 to 5, fall of 17 per cent.
Diseases of the skIN_ which fell from 6 to 5, a fall of 17 per cent.
The admission rate for DIARRHOEA in 1944 was 29 per 1,000. Sur-
prisingly, there were no recorded admissions for this disease in 1945.
Admission rates of the diseases which follow increased in 1945:

PNEUMONIA from NIL to 9

P.U.O. and N.Y.D. Fever from 37 to 52, arise of 4o per cent.
TONSILLITIS from 17 to 28, arise of 65 per cent.
SEPTIC CONDITIONS from 17 to 42, a rise of 147 per cent.

Although some of these increases appear alarming, it must be
remembered that, with such a small population, the admission of an
additional few cases can increase the rate per 1,000 to a large extent.
The reverse applies in considering the reductions noted above.

ALL INDIAN TROOPS

The rates of admission for all Indian Troops are presented in Table
128 which combines Tables 124 to 127.

The peak admission rate for diseases only occurred in 1943 at
1,072 per 1,000 Troops, followed by 1944 when admissions were 868,
then by 1942 at 849. In 1945 there occurred a fifty per cent. reduction
in admissions at 421 per 1,000.

Admissions for Injuries, however, showed successive annual rises
from a rate of 41 in 1942 to an increase of slightly over one hundred per
cent. at 84 in 1945. Intervening rates were 50 in 1943 and 78 in 1944.

Total admissions were 890 in 1942, 1,123 in 1943, 946 in 1944 and
505 in 1945.

The trend of admissions was similar to that experienced for all
British Troops, but the rates of increase and decrease differ somewhat
as indicated in the table below.

Indo-Burma Front. Admissions for All Diseases
Comparison between All British and All Indian Troops, 1942-45

All British Troops All Indian Troops
Percentage increase Percentage increase
or decrease over or decrease over
Year Rate Rate
per 1,000 | preceding 1942 per 1,000 | preceding 1942
year year
1942 990 — = 849 = ca
1943 1,576 +59 +59 1,072 +26 +26
1944 1,218 — 23 +23 868 -19 +2
1945 689 — 43 —30 421 —51 —51

—_—_

THE ARMY MEDICAL SERVICES 369

If, however, certain tropical diseases are eliminated—those diseases
which characteristically show higher rates for Europeans—the com-
parison undergoes a complete change and the percentage increases and
decreases are not so pronounced. Those eliminated are Malaria, P.U.O.
and N.Y.D. Fever, Dysentery and Diarrhoea.

Indo-Burma Front. Admissions for Certain Diseases
Comparison between All British and All Indian Troops, 1942-45

All British Troops All Indian Troops

Percentage increase Percentage increase
or decrease over or decrease over

Year Rate =) Rate
per 1,000 | preceding per 1,000 | preceding
1942 year 1942
1942 501 _ —_ 329 _ _
1943 750 +49 +49 462 +40 +40
1944 525 —30 +5 374 19 +14
1945 453 14 —10 302 19 - 8

The above table shows that in 1943 (the peak year of admissions)
the percentage increase for British over 1942 was 49 as against 40 for
the Indians. This compares with increases of 59 and 26 per cent. as
shown on the table for all diseases. It also shows that if 1942 is taken as
the basic year, the 1945 rate for British Troops was ten per cent. less
as against the Indian eight per cent. It indicates too, that the percentage
decrease in 1944 as compared with the preceding year was half as much
again among British Troops, but that in 1945 the percentage decrease
among Indians, as compared with 1944, was half as much again as the
British.

WEST AFRICAN OTHER RANKS

West African Units joined the Indo-Burma Front early in 1944.
Because of this, and as data relating to their admissions to hospitals
are available only to September 1945, Equivalent Annual Rates based
on the known admissions during these years have been computed and
are presented in Table 129. These Equivalent Annual Rates will allow
of more valid comparisons. The West African Units were led by British
Officers and many British Warrant Officers and N.C.Os. were attached
to them. Admissions to hospitals of such personnel have been included
in the tables relating to British Officers and British Other Ranks.

Admissions for diseases were less than any other class of combatant
troops on this front, at 621 and 402 per 1,000 for the two years. This
compares with 1,334 and 780 for British Other Ranks, with 912 and
466 for Indian Other Ranks and 741 and 424 for East African Other
Ranks. The rates for N.Cs.(E.) were 743 and 279.

370 CASUALTIES AND MEDICAL STATISTICS

Injury rates, which were also lower than those recorded for other
classes of active troops, were 50 and 74 per 1,000 respectively.

Total admission rates were 671 in 1944 and 476 in 1945.

Perhaps the most remarkable fact emerging from the table is the
low incidence of MALARIA which in 1944 was 39, and, in 1945, 10 per
1,000 troops! Admissions for P.U.O. and N.Y.D. Fever, which may
have included some undiagnosed Malaria cases, also compared very
favourably with all other classes of Other Ranks. Relevant rates are
as follows:

Indo-Burma Front. Admissions of Other Ranks for
(i) Malaria and (ii) P.U.O. and N.Y.D. Fever.
Comparison between W.A.O.Rs. and Other Classes of O.Rs., 1942-45

1.0.Rs. | N.Cs.(E.) E.A.0.Rs.

1944 | 1945

(i) Crude Rates
alaria.
P.U.O. and N.Y.D.
ever.

Totals : 84

{ii) Comparative Rates
Malaria.

Admission rates for Malaria in respect of B.O.Rs. vis d vis W.A.O.Rs.
were ten and thirteen times as high; for I.O.Rs., eight and seven times,
N.Cs.(E.) seven and four times; and E.A.O.Rs. twice and one and a
quarter times as high.

For P.U.O. and N.Y.D. Fever, the disparity between admission
rates is much lower. Among B.O.Rs. they were four times and twice
the W.A.O.R. rates; among I.0.Rs. two and a half and one and a half
times; among N.Cs.(E.) twice the rate in 1944 and equal in 1945;
while among E.A.O.Rs. the 1944 rate was over twice and, in 1945,
less at seven-eighths the W.A.O.R. rate.

It is to be noted that the rates for P.U.O. and N.Y.D. Fever among
W.A.O.Rs. and E.A.O.Rs. are higher than those for Malaria.

Another interesting feature of this table is the ratio between the
rates in 1944 among E.A.O.Rs. For Malaria it was 221 to 100 and for
P.U.O. and N.Y.D. Fever, practically identical at 220 to 100.

In contrast to Malaria, the rates for VENEREAL DISEASES were of a
relatively high order, being go per 1,000 in 1944 and 69 in the following
year. The 1944 admission rate was the highest recorded for this group
of diseases in that year, and the second highest in the campaign (the
highest rate recorded was by B.O.Rs. at 158 in 1943). The rate for
1945, 69 per 1,000, was lower than that for B.O.Rs. at 72, and for

THE ARMY MEDICAL SERVICES 371

E.A.O.Rs. at 83, but higher than for I.0.Rs. at 46 and N.Cs.(E.) at
32 per 1,000.

High in the admission rates was DYSENTERY at 52 per 1,000 in 1944,
but this was more than halved to 22 in 1945. A similar decline was
experienced with DIARRHOEA from 29 in 1944 to 13 in 1945.

Other Diseases for which admissions declined in 1945 were:

SEPTIC CONDITIONS from 32 to 29 per 1,000
INFECTIVE HEPATITIS from 21 to 6 per 1,000
Other Diseases of the RESPIRATORY System from 31 to 26 per 1,000
Other Diseases of the DIGESTIVE System from 23 to 11 per 1,000
SMALLPOX from 3:2 to 1-2 per 1,000

Admissions for the following diseases registered increases in 1945:

PNEUMONIA from 14 to 23 per 1,000
Diseases of the EYE from gto 11 per 1,000
MENTAL PSYCHONEUROTIC and

PERSONALITY DISORDERS from 3°3 to 4°5 per 1,000
MUMPS from 1-4 to 2°5 per 1,000

Diseases for which similar rates were experienced in both years were:

Diseases of the SKIN 16-0 and 16-7 per 1,000
COMMON COLD 6-8 and 6-7 per 1,000
Diseases of the cIRCULATORY System 2-6 and 2-4 per 1,000
TONSILLITIS 1-9 and 1-9 per 1,000
TUBERCULOSIS 0-52 and 0-65 per 1,000

EAST AFRICAN OTHER RANKS

East African Units were first drafted to the Indo-Burma Front in
May 1944. Admissions for that year have been adjusted to Equivalent
Annual Rates (Table 130). A similar adjustment has been made in
1945 for which year data are available only to September. As with
W.A.O.Rs. admissions of British ranks attached to East African Units
have been included in the relevant British tables.

Admissions for diseases only were of the order of 741 per 1,000 in
1944 and 424 in 1945. These rates exceeded those for W.A.O.Rs. but
were less than for B.O.Rs. and I.0.Rs. The 1944 rate was almost
identical with that for N.Cs.(E.), but in 1945 admissions of E.A.O.Rs.
were fifty per cent. higher.

Injuries recorded rates of 85 and 74 per 1,000, while total admissions
were 827 and 498 respectively.

A notable feature of admissions was the fiat rate for DYSENTERY at
146 per 1,000 in 1944. This was the highest recorded rate on this
Front and, among male troops, compares with 132 per 1,000 for

13CMS

372 CASUALTIES AND MEDICAL STATISTICS

B.O.Rs. in 1943, the second highest rate. It was nearly three times the
rate for All Troops in 1944. In 1945 it declined to 51, which was
almost identical with the All Troops rate.

MALARIA accounted for admissions at rates of 86 in 1944 and 13 in
1945 which exceeded those for W.A.O.Rs. but were less than the rates
for the other classes.

Admissions for P.U.O. and N.Y.D. Fever were higher than those for
Malaria at 99 in 1944 and 17 in 1945. In both cases the decline was over
eighty per cent.

The rate for VENEREAL DISEASES increased by over fifty per cent.,
from 52 in 1944 to 83 in 1945. The latter rate was the highest recorded
for this group of diseases on the front in 1945.

Other diseases, admissions for which registered higher rates in 1945
were:

Diseases of the SKIN from 17 to25 per 1,000
MENTAL, PSYCHONEUROTIC and

PERSONALITY DISORDERS from 6 to g per 1,000
INFECTIVE HEPATITIS from 5 to 6 _ per 1,000
TUBERCULOSIS from 0:29 to 1°03 per 1,000

Other diseases for which admissions declined were:

SEPTIC CONDITIONS from 48 to 26 per 1,000
DIARRHOEA from 38 to 10 per 1,000
Other Diseases of the RESPIRATORY SYSTEM _ from 30 to 16 per 1,000
COMMON COLD from 23 to 5 per 1,000
PNEUMONIA from 13 to 8 per 1,000
Diseases of the EYE from 11 to 8 per 1,000
Discases of the EAR, NOSE and THROAT from 10 to 7 per 1,000

There were little differences in the admission rates of Mumps,
Smallpox, Tonsillitis, Diseases of the Circulatory System and Other
Diseases of the Digestive System.

ALL TROOPS

Rates of admissions to hospitals for all troops on the Indo-Burma
Front for the years 1942 to 1945 are given in Table 131. Admissions
during 1945 are known for the first nine months only, and Equivalent
Annual Rates have been computed from this data.

Admissions for diseases, in general, followed the trend indicated
by the numerically larger classes of troops, and showed an increase in
1943, followed by declines in both the subsequent years. That the rates
are similar to those for V.C.Os. and I.O.Rs., particularly in 1942 and
1945, is shown in the table below:

THE ARMY MEDICAL SERVICES 373

Indo-Burma Front. Admissions for All Diseases of
(i) vai Troops and (ii) V.C.Os. and I.O.Rs., 1942-45.
le and Comparative Rates

Crud
rr
1942 1943 | 1944 1945
(i) Crude Rates
Troops . cs 2 3 + 885 1,1§1 993 462
V.C.Os. and 1.0.Rs. . S 4 877 1,073 Ir 466
(ii) Comme Rates All Troops = 100
All Troo; . . 100 100 100 100
V.C.Os. Eid L Oo. Rs. ‘ ‘ . 99 93 92 101
(iii) Comparative Rates 1942 = 100
Troops . 2 : = . 100 130 112 52
V.C.Os. and 1.0.Rs. 2 7 a 100 122 104 53
(iv) Comparative Rates preceding year base
All Troops . A . - 130 86 47
V.C.Os. and 1.0.Rs. S : _ 122 85 51

In 1942 and 1945 there was a difference of only one per cent. between
the rates for All Troops and I.0.Rs.; in 1943 it was seven and in 1944
eight per cent. less. Compared with the 1942 rates, in 1943 and 1944
the I.0.Rs. rates were eight per cent. less and in 1945 one per cent.
more. When rates are compared with those of the year immediately
preceding, admissions of All Troops in 1943 were 130 per cent. of those
in 1942, in 1944 they were 86 per cent. and in 1945, 47 per cent. of the
previous year’s rates. Rates for I.0.Rs. are very similar at 122, 85 and
51 per cent.

Injuries accounted for admissions at rates of 42 per 1,000 in 1942,
54 in 1943, 95 in 1944 and 89 in 1945. Here again, rates correspond
closely with those of I.0.Rs. (except in 1945), for whom the rates were
43, 56, 93 and 102 respectively.

The rates of admissions for disease and injuries ranged from 551 in
1945 to 926 in 1942, 1,088 in 1944 to a peak of 1,205 in 1943. That
1943 was the peak year of admissions was to a large extent due to a great
increase in the number of Malaria cases, and the rate of 491 per 1,000
must have contained a considerable number of re-admissions due to
relapse. As figures of such relapse cases are not available, it is not
possible to judge their impact on admissions.

MALARIA with P.U.O. and N.Y.D. Fever were responsible for
approximately one-half the admissions for disease during the first
three years under review. In 1945, the combined rates were only one
fifth of the total. The effect of these diseases on the total disease rates is
shown below.

The range of all diseases was 689 (1,151 less 462), but when Malaria
and P.U.O. and N.Y.D. Fever were eliminated it was only 218 (590
less 372). Between 1942 and 1944, Other Diseases rates were just over

374 CASUALTIES AND MEDICAL STATISTICS

Indo-Burma Front. Comparison of Admission Rates
All Diseases with Malaria and P.U.O. and N.Y.D. Fever
All Troops, 1942-45.

1942 1943, 1944 1945

All Diseases. 9. 885 1,151 993 462
Malaria . A - | 395 491 329 63
P.U.O. and N.Y.D. Fever 30 425 jo 561 | 120 449 27 go

Other Diseases 2 a 460 590 4 544 372

Other Diseases as
Percentages of All
Diseases . ‘

one half of those for All Diseases, but, in 1945, when Malaria and P.U.O.
and N.Y.D. Fever admissions had been reduced considerably, the rate
was four-fifths that for All Diseases.

The rates for VENEREAL DISEASES remained remarkably steady, except
for 1943 when it rose from 50 to 81 per 1,000. For 1944 and 1945 they
were 47 and 48. Although it may have been anticipated that the rate
would increase in 1945 after the collapse of the Japanese resistance, that
this did not occur was probably due in no small way to the crusading
efforts of unit medical officers and the establishment of prophylactic
centres as well as to the high morale of the troops and the provision of
increased amenities.

Admissions for DIARRHOEA and DYSENTERY were considerably less in
1945 than in 1942, the former declining by forty and the latter by
sixty per cent. In the case of Diarrhoea, admissions rose in 1943 and
again in 1944 from 29 to 35, followed by 46, but declined in 1945 to 18.
Admissions on account of Dysentery fell in 1943 from 59 to 48, increased
in 1944 to 54 and declined to 25 in the following year. The decrease in
1945 was probably attributable to the acclimatisation of considerable
numbers of unseasoned troops arriving in the area, particularly in 1943
and 1944.

INFECTIVE HEPATITIS accounted for a steady increase in the rate of
admissions in 1943 and 1944 from 2 per 1,000 to 6 in 1943 and 17 in
1944. The rate for 1945 was slightly less at 15. Information regarding
the causes of this increase is lacking, but it is possible that in these
figures are included some admissions for Post-arsphenamine Jaundice.

Admissions for MENTAL, PSYCHONEUROTIC and PERSONALITY Disorders
also showed a steady increase throughout the period, commencing with
2 in 1942 and followed by 4 in 1943, 6 in 1944 and 9 in 1945. The
cause of this increase was, no doubt, the cumulative effect of the stress
and strain of war and to more accurate diagnoses, following an increase
in the number of psychiatrists available in the Command.

THE ARMY MEDICAL SERVICES 375

Diseases of the SKIN accounted for admissions at rates of 20 in 1942,
27 in the two subsequent years, and 25 in 1945. Admissions for
SCABIES, which are omitted from the foregoing figures, commenced
at 14 per 1,000 in 1942, rose to 25 in the following year, and then fell
to 20 in 1944 and to g in 1945.

Admissions for COMMON COLD fluctuated between 14 and 32 per
1,000, Diseases of the EAR, NOSE and THROAT between 13 and 21, and
Diseases of the EYE between g and 18 per 1,000. In each case, the
higher rate was recorded in 1943.

TONSILLITIS was responsible for admissions at rates which were
remarkably constant during the four years at 6, 6, 5 and 5 per 1,000
respectively.

Admissions for SANDFLY FEVER were low at rates which varied from
0°5 per 1,000 in 1945 to 0-8 in 1942 and 1943. In India, the rates for
this disease among B.O.Rs. varied between 5-3 and 38-1 per 1,000,
and, among I.0.Rs. between 0-7 and 16 per 1,000. The reason for this
large difference in rates between the two areas is that this disease is
usually mainly associated with the North-West Area of India. Admissions
to hospitals in Bengal for Sandfly Fever were usually only a fraction of
those in the Punjab and North-West Frontier.

In 1942, admissions for DENGUE FEVER were I1 per 1,000. They
declined in 1943 when the rate was 4. This was followed by a further
decrease to 1 per 1,000 in both 1944 and 1945.

The appointment of an A.D.MLS. (Nutrition), and the co-operation
of civilian nutrition experts, were probably responsible for the decline
in admissions from diseases due to Disorders of NUTRITION. The rates
recorded were 0-10 per 1,000 in 1942, 0°36 in 1943, 0°03 in 1944 and
0-07 in 1945. To these rates must be linked the fact that recruits to the
Indian Army in particular were of a much lower standard in the latter
years of the war, and it is not unreasonable to suggest that had not
rigorous steps been taken to build up recruits and to combat the diseases,
many more admissions would have occurred in 1944 and 1945.

Admissions for SEPTIC CONDITIONS and Other Diseases of the
DIGESTIVE and RESPIRATORY Systems followed the general trend of a
rise in 1943, with successive falls in the two subsequent years. Rates
varied in the case of Septic Conditions from 35 in 1943 to 20 in 1945,
in Other Digestive Diseases from 43 in 1943 to 21 in 1945 and in Other
Respiratory Diseases from 42 in 1943 to 30 in 1945.

The rates for Mumps declined from 7 per 1,000 in 1942 to 5 in 1944
and 1945 while those for DIPHTHERIA remained fairly constant ranging
from 0-16 in 1944 to 0:29 in 1943.

Admissions for the ENTERIC Group of Fevers showed a gratifying
constant decline during the period from 0-95 in 1942 to 0-27 in

1945.

376 CASUALTIES AND MEDICAL STATISTICS

Conclusions

The most gratifying feature of the tables presented in this chapter
undoubtedly is the dramatic reduction in the incidence of Malaria.
That a similar reduction was experienced in other tropical and sub-
tropical countries does not detract from the remarkable achievement
of the medical authorities in reducing admissions from nearly 500 to
63 per 1,000 troops in three years, in a country which contains what is
probably one of the worst malarious areas in the world.

Satisfactory results in the campaign against Diarrhoea and Dysentery
are indicated in the decrease in admission rates of these diseases.

Against these achievements are recorded increases in the admission
rates of Infective Hepatitis from 2 per 1,000 in 1942 to 15 in 1945, and
of Mental, Psychoneurotic and Personality Disorders, admission rates
of which rose from 1-8 per 1,000 in 1942 to 9:2 in 1945.

INJURIES

Table 132 shows the admission rates on account of Injuries. As with
diseases, figures are given separately for all classes of troops in the area
and have been broken up into those caused through Enemy Action
(E.A.) and those designated Non-Enemy Action (N.E.A.). In the theatre,
the criterion for deciding on the attributability of an injury to Enemy
Action appears to have been whether it was caused by blast, bombs,
gunshot or shell. If the cause was other than this, the injury was
classified as N.E.A. The latter was not split into categories up to and
including 1943 and even in the two years which followed -N.E.A.
injuries were broken down only to ‘Burns and Scalds’ and ‘Other’.
‘Other’ injuries, naturally more numerous than Burns and Scalds,
contain interesting data relating to traffic accidents, training injuries,
etc., as well as to those which, on other fronts, would be considered
as caused by E.A.

Total admissions for injuries ranged from 42 per 1,000 in 1942 to
95 in 1944. The rates for 1943 and 1945 were 54 and 89. In 1942 and
1943 they accounted for slightly under five per cent. of All Admissions,
but, in the two years which followed, rose to nine and sixteen per cent.
Although an increase in the number of admissions for injuries accounted
toa great extent for the percentage increase in 1944, that for the following
year was wholly due to the unprecedented decrease in admissions for
disease.

N.E.A. Injuries

These were the more numerous, being from fifty to eighty-five per
cent. of all injuries. The rates were 36 in 1942, 45 in 1943, 48 in 1944
and 50 in 1945. A condensed table relating to these injuries is given
below for comparison purposes.

THE ARMY MEDICAL SERVICES 377

Indo-Burma Front. Admissions to Hospitals, N.E.A. Injuries
All classes of Male Troops, 1942-45.
Rates per 1,000 Strength

1942 1943 1944 1945
British Officers . ‘i - _ 30 33 3r 31
British Other Ranks . é 5 33 64 55 61
V.C.Os. and I.O.Rs. . é ? 38 46 48 57
N.Cs.(E.) soos 33 37 30 26
W.A.O.Rs. 34 36
E.A.O.Rs. 40 53

B.O.Rs. suffered more injuries than any other class of troops. Apart
from 1942 when the rate was comparatively low at 33 per 1,000,
admissions ranged from 55 to 64. V.C.Os. and I.0.Rs. next in order of
admissions produced rates which increased each year from 38 in 1942
to 57 in 1945. The rates of British Officers were fairly constant through-
out the years at from 30 to 33 per 1,000. Those for N.Cs.(E.) were 33
in 1942, 37 in 1943, 30 in 1944 and 26 in 1945. The highest rate for
N.Cs.(E.) was slightly lower than the lowest for V.C.Os. and I.0.Rs.

W.A.O.Rs. and E.A.O.Rs. who were in the area during 1944 and
1945 only, produced rates which were less than those of B.O.Rs. or
V.C.Os. and I.0.Rs.

It is to be noted that, of the troops who were in the area for the
four years, the highest rates of admissions were in 1943, except for
V.C.Os. and I.0.Rs. among whom the highest rate occurred in 1945.
E.A. Injuries

These were lowest in 1942 and 1943 at 6 and 8 per 1,000 respectively.
Admissions rose to 47 in 1944 and fell to 39 in the following year.
1944 also produced the highest rate of N.E.A. Injuries at only 1 per
1,000 more than E.A. Injuries. The table which follows condenses the

information shown in Table 136 as to E.A. Injuries by classes of
personnel.

Indo-Burma Front. Admissions to Hospitals, E.A. Injuries
All Classes of Male Troops, 1942-45.
Rates per 1,000 Strength

British Officers

itl . : ‘ a 5 15 56 42
British Other Ranks . : 5 14 102 73
V.C.Os. and I.0.Rs. . 6 10 45 44
N.Cs.(E.) . 1 1 5 2
W.A.O.Rs. 16 38
E.A.O.Rs.

378 CASUALTIES AND MEDICAL STATISTICS

As with N.E.A. Injuries, B.O.Rs. suffered higher rates of E.A.
Injuries than any other class of troops. Rates for them rose from 5 in
1942 to 14 in 1943, to a peak of 102 in 1944 and then declined to 73
in the following year. Rates for V.C.Os. and I.0.Rs. were much less,
ranging from 6 in 1942 to 10 in 1943, to 45 in 1944 and finally to 44
in 1945.

British Officers recorded rates which in general were slightly higher
than those for V.C.Os. and I.0.Rs.; commencing at § in 1942 they rose
to 15 in 1943, followed by 56 in 1944 and 42 in 1945.

As might have been expected, rates for N.Cs.(E.) were very low at
I per 1,000 in both 1942 and 1943, 5 in 1944 and 2 in 1945.

The peak rates of injuries occurred in 1944, except for W.A.O.Rs.
whose rate of 38 in 1945 was slightly more than twice the 1944 rate.
E.A.O.Rs. rates were 45 in 1944 and 21 in 1945.

Gunshot wounds were predominant in each year. They ranged from
fifty to sixty-five per cent. of the total E.A. wounds. During the two
years when fighting was at its heaviest, however, in 1944 and 1945,
gunshot wounds recorded lower percentages of injuries than in the
two previous years. In 1944 and 1945 injuries due to bombs and shells
were almost identical and between them accounted for nearly half the
injuries.

Conclusions

B.O.Rs. sustained higher rates of injuries, both N.E.A. and E.A.,
than any other class of troops. In general, E.A. Injuries were far less
numerous than N.E.A., although, in 1944 and 1945, E.A. Injuries
increased considerably. The greatest number of N.E.A. Injuries
occurred in 1945 while E.A. Injuries were more frequent in 1944.

The largest contribution to E.A. Injuries was Gunshot wounds,
with Bomb and Shell wounds together almost equalling Gunshot
wounds in the last two years of the campaign.

DEATHS

Data regarding deaths in hospitals are very meagre. All that can be
ascertained are the rates of deaths by the various categories of troops
in each year divided, from 1943, into those caused by diseases and
N.E.A. Injuries, and those caused by E.A. Injuries. The rates relating
to these deaths are given in Table 133.

It must be emphasised that the statistics in this table relate to deaths
in hospitals only, and do not include those which occurred in other
medical establishments, or on the field of battle.

Deaths were more numerous in 1944, during which year also occurred
the highest rates of admissions on account of injuries. During 1944

THE ARMY MEDICAL SERVICES 379

and 1945 when fighting was at its highest, there were, in general, more
deaths in hospital on account of Disease and N.E.A. Injuries than there
were from E.A. Injuries. The only exception to this was in the case of
British Officers who recorded rates of 3-3 in 1944 and 2:9 in 1945 from
E.A. Injuries as against 3-2 and 1-6 from other causes.

Rates for B.O.Rs. were higher than for any other class, both from
E.A. Injuries and from other causes. Deaths from the latter were one
and a half times those of the former.

The second highest rates of deaths from Enemy Action was recorded
by British Officers. The rate for other causes was approximately fifty
per cent. higher on the average during the four years.

Among V.C.Os. and I.0.Rs. the death rate for other causes was
nearly three times that for E.A. Injuries.

The rates for N.Cs.(E.) were approximately 0-2 per 1,000 for E.A.
Injuries and 3-4 for others. The low rate for the former was to be
expected when the low rates of admissions to hospitals for this class
are considered.

W.A.O.Rs. recorded death rates of 0-4 in 1944 and 1-2 in 1945 from
E.A. Injuries and 3-8 and 3-5 for all other causes. Rates for E.A.O.Rs.
were slightly higher at 0-8 and 1-5 for E.A. Injuries and 5-0 and 3-2
for all other causes.

MEDICAL ETHNOGRAPHY ON THE
INDO-BURMA FRONT

In relating the ethnic variations of disease on the Indo-Burma Front,
the fact that two of the four classes of troops engaged in this area were
there for only two years must be taken into account. This is all the
More important since rates, in general, were far less in the two final
years, and particularly in 1945, owing, chiefly, to the remarkable
decrease in admissions for Malaria.

From the data available, and in order to make more valid comparisons
this study is divided into two parts:

(i) A comparison between B.O.Rs. and V.C.Os. and I.O.Rs. and
(ii) A comparison between B.O.Rs., V.C.Os. and I.0.Rs., W.A.O.Rs.
and E.A.O.Rs.
The first is based on known admissions for the four years 1942 to
1945 and the second on similar information for the two years 1944

and 1945.
To enable comparisons to be made, average rates of admissions have

been computed for:
(i) Four years in respect of B.O.Rs. and V.C.Os., and I.0.Rs. and
13CMS*

380 CASUALTIES AND MEDICAL STATISTICS

(ii) Two years in respect of B.O.Rs., V.C.Os. and I.0.Rs., W.A.O.Rs.
and E.A.O.Rs.

and comparative tables prepared based on B.O.Rs. who are shown at

100 for each disease. Because of the differing annual rates and more

especially as those for 1944 and 1945 were substantially lower than

for the previous years, the average rates shown against V.C.Os. and

1.0.Rs. for the years 1942 to 1945 will differ somewhat from those for

the years 1944 and 1945. These statistics are presented as Tables 134
and 135.

B.O.RS. AND V.C.OS. AND I.O.RS.

Table 134 shows the comparative rates of admissions on account of
diseases only for B.O.Rs. and V.C.Os. and 1.0.Rs. As the total disease
rate among the latter was some seven-tenths that of B.O.Rs., it is not
surprising that with only a few diseases were the Indian rates higher.

Of these diseases, MUMPS recorded a much higher incidence, being
slightly under twenty times the British rate. PNEUMONIA was three
times, TUBERCULOSIS twice and COMMON COLD and Diseases of the EYE
both one and a half times the rate for B.O.Rs. These higher incidences
were not unexpected having regard to the experiences of these classes
of troops in India and elsewhere.

The Indian rate for scaBIES was nearly twice that of B.O.Rs. This is
in accord with war-time experience in India and Ceylon but is at
variance with that in B.N.A.F. and C.M.F., where the British rate
was approximately twice that of the Indians, or in the Middle East,
where the rates were roughly equivalent.

At the other end of the scale, admissions of B.O.Rs. for DENGUE
FEVER were sixteen times the Indian rate and, for DIPHTHERIA, eight
times. The British rates for SANDFLY FEVER, the ENTERIC Group of Fevers
and for INFECTIVE HEPATITIS were six, four and three times, respectively,
the Indian rate. Admissions for DIARRHOEA and DYSENTERY among
B.O.Rs., as might be expected, were from two to three times those of
the Indians. Those for MENTAL, PSYCHONEUROTIC and PERSONALITY
Disorders were also approximately three times greater.

Diseases which, among Indians, recorded approximately fifty per
cent. of the B.O.R’s. rates were VENEREAL DISEASES, Other Diseases of the
DIGESTIVE System, Diseases of the sKIN, and Other Diseases of the
RESPIRATORY System.

Admission rates for SMALLPOX among the Indians were three-fifths of
the British rates, as were Diseases of the EAR, NOSE and THROAT.

Rates of admissions on account of septic Conditions for both classes
were practically identical.

MALARIA accounted for Indian admission rates at approximately
nine-tenths those of the British, while those for P.U.O. and N.Y.D.

THE ARMY MEDICAL SERVICES 381

Fever were three-quarters. Comparison of annual rates, as under,
leads to some interesting conclusions.

Indo-Burma Front, Admissions of
B.O.Rs. and V.C.Os., and I.O.Rs.

for
(i) Malaria and (ii) P.U.O. and N.Y.D. Fever.
Crude and Comparative Rates, 1942-45

1942 1943 1944 1945
(i) MALARIA

(a) rae Rates A
= 3 Fi 335 628 406 12
V.C.Os. and 1L.O.Rs. | ¢ : 447 486 319 68

(b) comparative Rates (B.O.Rs. = 100)

P : é 100 100 100 100
ee: and I.0.Rs. 2 “ re 133 7 78 53
(c) Comparative Rates (1942 = 100)
B.O.Rs. : 7 Fi 100 185 121 38
Pee and I.0.Rs. : a x 100 109 71 15
(d) Comparative Rates
(Preceding year = 100)
B.O.Rs. B ? e 185 65 29
V.C.Os. and .O.Rs. | 3 is 109 66 21
(ii) P.U.O. AND N.Y.D. FEVER
(a) Crude Rates
B.O.Rs. . . - ci 36 82 169 42
V.C.Os. and I.O0.Rs. | ‘ ‘ 30 72 115 28
(b) Comparative Rates (B.O.Rs. = ee)
B.O.Rs. i 2 100 100 100 100
V.C.Os. and LO.Rs. | Xs : 83 88 68 69
(c) Comparative Rates (1942 = 100)
B.O.Rs. 5 ¥ a 100 228 469 117
V.C.Os. and I.0.Rs. | < ‘. 100 240 383 93
(d) Comparative Rates
(Preceding year = 100)
B.O.Rs. ‘ ‘ 228 206 25
V.C.Os. and 1.0. Rs, . - a 240 160 24

In 1942 the Malaria rate for Indians was one-third higher than the
British rate. During the two following years it was slightly over three-
quarters and in 1945 was one-half the rate for B.O.Rs. Compared with
1942, the Indian rate, in 1945, had fallen by eighty-five per cent.,
while the British rate fell by only sixty per cent. When the rates are
compared with those of the preceding year, the fall in the British rate
in 1944 was almost seventy per cent. and that of the Indians nearly
eighty per cent.

For P.U.O. and N.Y.D. Fever, admission rates of the Indians were
lower than those of the British by from ten to thirty per cent. In 1942

382 CASUALTIES AND MEDICAL STATISTICS

and 1943 the Indian rates were eighty-three and eighty-eight per cent.
of the British rates and in 1944 and 1945 they were sixty-eight and
sixty-nine per cent. Compared with the previous year, the percentages
varied little in 1943, while they were almost identical in 1945. In 1944
the British rate was twice and the Indian one and a half times those
of 1943. The 1945 rates in each case were one quarter the 1944 rates.

Summary
Morbidity rates on the Indo-Burma Front for B.O.Rs. as compared
with V.C.Os. and I.0.Rs. may be summarised as below:

Diseases with comparatively | Diseases with comparatively | Diseases with little
High rates (in descending Low rates (in descending difference in rates
order) order)
Dengue Fever
Diphtheria
Sandfly Fever

Enteric Group of Fevers
Infective Hepatitis

Mental, Psychoneurotic and Mumps Septic Conditions
Personality Disorders Pneumonia Malaria

Dysentery Tuberculosis Disorders of Nutrition

Diarrhoea Common Cold P.U.O. and N.Y.D.

Diseases of the Skin Diseases of the Eye Fever

Other Diseases of the Diseases of the
Digestive System Circulatory System

Venereal Diseases

Other Diseases of the
Respiratory System

Disease of cof the Ear, Nose

OTHER RANKS, ALL GROUPS

Table 135 shows the comparative rates of admissions on account of
diseases only for B.O.Rs., V.C.Os. and I.0.Rs., W.A.O.Rs., and
E.A.O.Rs. As noted above, average rates for two years only have been
used in this table, because W.A.O.Rs. and E.A.O.Rs. were in this area
for two years only, and because a valid comparison can be made, in
this instance, only with data of the same two years relating to the other
groups.

The rates of total admissions for Diseases indicates that for every
100 B.O.Rs. admitted to hospital, there were also admitted 65 V.C.Os.
and I.0.Rs., 55 E.A.O.Rs., and 48 W.A.O.Rs.

Perhaps the most striking feature of this table is that there were
three causes for which the rates of all other groups were higher than
those for B.O.Rs. These were PNEUMONIA, MUMPS and TUBERCULOSIS.

Other outstanding features of this table are:

THE ARMY MEDICAL SERVICES 383

(i) Indian and West African Troops were more prone to SEPTIC
Conditions.

(ii) Indian Troops were more liable to scABIES, COMMON COLD and
Diseases of the EYE.

(iii) West Africans were more susceptible to SANDFLY FEVER.

(iv) British and Indian Troops were more liable to contract
macaria than were Africans.

(v) British Troops were more prone to P.U.O. and N.Y.D. Fever
and Other Diseases of the DIGESTIVE System.

(vi) British Troops were more liable to be admitted to hospital
with DIARRHOEA, DENGUE FEVER, INFECTIVE HEPATITIS, the
ENTERIC Group of Fevers, Diseases of the EAR, NOSE and
THROAT, Diseases of the SKIN, and MENTAL, PSYCHONEUROTIC
and PERSONALITY Disorders.

(vii) W.A.O.Rs. were more prone to contract VENEREAL DISEASES
than B.O.Rs. and E.A.O.Rs. who were twice as likely to contract
them than Indians.

(viii) British and East Africans were more liable to DysENTERY than
were Indians or West Africans.

These indications are tabulated below.

Ethnic group
DISEASE

Prone Less Prone
Malaria British, Indians Africans
P.U.O. and N.Y.D. Fever British West Africans
Sandfly Fever West Africans
Dengue Fever British Indians, Africans
Enteric Group of Fevers British Indians
Common Cold Indians Africans
Mumps Indians, Africans British
Pneumonia Indians, Africans British
Tuberculosis Indians, Africans British
Infective Hepatitis British Indians, Africans
Scabies Indians Africans
Skin Diseases British Indians, Africans
Septic Conditions Indians, West Africans | British, East Africans
Eye Diseases Indians
Venereal Diseases West Africans, British | Indians
Diarrhoea British Indians, Africans
Dysentery British, East Africans Indians, West Africans

Other Diseases of the
Digestive System

Ear, Nose and Throat
Diseases

Mental, Psychoneurotic

and Personality Disorders

British
British

British

Africans
Africans

Indians, Africans

384 CASUALTIES AND MEDICAL STATISTICS

TABLE 120

South-East Asia Command (Indo-Burma Front)
Causes of Admissions to Hospitals, 1942-45. British Officers
Annual Rates per 1,000 Strength

Source: A.F. A.31-B

CAUSES

Fateric Group of Fevers
fective Hepatitis -
Malaria

9 | Mumpe
to | Pneumonia

11 | P.U.O. and N.Y.D. Fores
12 Sandfy Fever .

4

1s Sclipo |

16 | Tuberculosis . . . . .
1 Venereal Diseases . . . .
1 Diseases of the Circulatory S: 2
19 Diseases due to Disorders of Nutrition .
20 | Diseases of the Ear, Nose and Throat .

1

2

3

4 ‘ever
5 Diphtheria .
6

22 Breese of the be Skin n (other than Scabies)

23 | Other Diseases of the Digestive System .
3 | Gher Dacanes of

2 Diseases of the Respiratory System
26 | Mental, Psychoneurotic and

Personality Disorders . .
27 «| All Other Diseases . . .

28 Total Admissions for Diseases. .

2 Injuries—N.E.A.
3° eee .

33 Total Admissions for Injuries
32 Total Admissions . . .

»

Bowwo s0oNed
)

* Any cases included in ‘‘All Other Diseases’.

Note: 1945 rates are equivalent, being based on the known admissions or the first

nine months of the year.

THE ARMY MEDICAL SERVICES 385

TABLE 121

South-East Asia Command (Indo-Burma Front)
Causes of Admissions to Hospitals, 1942-45. British Other Ranks

Annual Rates per 1,000 Strength
Source: A.F. A.31-B

1943 1944
1 | Common Cold . . . . . 1-7 21°3 18-50 1
2 | Diarrhoea . . ‘ . . £4 77°90 guar 2
3 pysea . . a . . 3 3 peed rae 3
4 jengue Fever. Ss : i g oe 4
5 Diphtheria . ‘ ‘ + ° P o-8 12 0-65 5
6 Enteric Group of Fevers > 9 14 0:8: 6
Infective Hepatitis . . a 570 27:2 31-4! Z
3 Malaria. é = Ps . 334°7 628-2 405°s8
lumps |. : : : ; ‘ Orr o's “24 9
19 Pneumonia . . . . : m2 * 0-85 10
ir | P.U.O. and N.Y.D. Fever . . . 36:3 82°3 si
1z_ | Sandfly Fever. . + + = 2 33 12
13 Scabies . 2 m e . . 79 16° 13
14 Smallpox . ‘s i = = : o-4 o8 14
1g | Tonsillitis . - . . : . * * 1§
16 ‘Tuberculosis $ i e a ‘ 0 o-9 0°42 0°64 16
r Venereal Diseases rie 157°9 69°23 72-19 at
1 Diseases of the Circulatory System’ 54 90 5°84 5°60 1
19 | Diseases due to Disorders of Nutrition 0-0 0-8 oO 0°68 | 19
20 | Diseases of the Ear, Nose and Throat 19°4 3674 26 26-20 | 20
21 Diseases of the Eye. 46 13-1 10-05 13704 | 23
22 Diseases of the Skin (other than Scabies) ge. 0-0 36°13 si-19 | 22
23 | Other Diseases of the Digestive System 1-0 a 32-69 34" 23
24 Septic Conditions . 2g°2 35°S 25-92 20-68 24
25 Other Diseases of the Respiratory ”
System . 53°6 69-0 50°10 §8-66 | 25
26 | Mental, Paychoneuratic and
Personality Disorders %, 2-5 6-1 10°88 23°24 26
27 =| All Other Diseases . : ‘i : 163-1 263°3 214°67 143°$7 | 27
28 Total Admissions for Diseases. « | 1,020°6 1,745°9 1,333°81 779°61 | 28
29 Injuries—N.E.A. * . ‘ Ps 33°2 64°4 54°81 60°77 29
jo Injuries—E.A. . < * f . 4s 13°9 1OI-gr 73°25 jo
3 Total Admissions for Inguries . 37°7 78-3 156-72 | 134-03 | 31
32 Total Admissions . . . «| 13,0584 | 1,824°3 | 1,490°53| 013-65 | 32

* Any cases included in ‘All Other Diseases’.

Note: 1945 rates are equivalent, being based on the know admissions for the first
nine months of the year.

386 CASUALTIES AND MEDICAL STATISTICS

TABLE 122

South-East Asia Command (Indo-Burma Front)
Causes of Admissions to Hospitals, 1942-45. Q.A.1.M.N.S.
Annual Rates per 1,000 St:

Source: A.F, A.31-B

CAUSES
1 | Common Cold I
2 | Diarrhoea . 3 ‘i 2
3 | Dysentery . 3
4 | Dengue Fever . 4
5 | Diphtheria . ‘ . 5
6 | Enteric Group of Fevers 6
7 | Infective Hepatitis 7
8 | Malaria 8
9 | Mumps 9
10 | Pneumonia 10
ir | P.U.O. and N.Y.D. Fevers rn
12 | Sandfly Fever. z 12
13 | Scabies é : : 13
14 | Smallpox 14
15 | Tonsillitis . 15
16 | Tuberculosis % 16
1 Venereal Diseases 17
5 Diseases of the Circulatory
System . 18
19 Discases due to Disorders of |
Nutrition : 19
20 | Diseases of the Ear, Nose
and Throat . . 20
21 | Diseases of the Be ar
22 | Diseases of the SI (other
than Scabies) 22
23 | Other Diseases of the
Digestive System. ‘ 23
24 | Septic Conditions ‘ 24
25 | Other Diseases of the
Respiratory System . 25
26 | Mental, Psychoneurotic and
Personality Disorders 26
27 | All Other Diseases , * 27
28 Total Admissions for
Diseases 3 28
29 | Injuries—N.E.A. 29
30 | Injuries—E.A. 30
31 Total Admissions for
Injuries * 31

Total Admissions

* Any cases included in ‘All Other Diseases’.

Note: 194, rates are equivalent, being based on the known admissions for the first
nine months of the year.

THE ARMY MEDICAL SERVICES 387

TABLE 123
South-East Asia Command (Indo-Burma Front)
Causes of Admissions to Hospitals, 1942-45. All British Troops
Annual Rates per 1,000 Strength
Source: A.F. A.31-B

CAUSES
1 | Common Cold . 1
2 | Diarrhoea . 2
3 | Dysentery . 3
4 | Dengue Fever | “ 4
5 | Diphtheria . af 5
6 | Enteric Group of Fevers u 6
7 | Infective Hepatitis » 7
8 | Malaria. 8
9 | Mumps. 7 ‘ 9

10 | Pneumonia . . 10

11 | P.U.O. and N.Y.D. Fever
12 | Sandfly Fever.

S8see sores

e 12
13 | Scabies C . * x 13
14 | Small : : 5 5 14
15 Tonsillitis e z “ 2 :

16 | Tuberculosis ‘
17 | Venereal Diseases .

I
1 Diseases of the Circulatory i.
System . 18
19 Discases due to Disorders of |
Nutrition 19
20 | Diseases of the Ear, Nose
and Throat . .

21 | Diseases of the E ye
22 | Diseases of the Skin (other
than Scabies) 32°99 3 22
23 | Other Diseases of the
Digestive System. s . . 49°76 : 23
24 | Septic Conditions . 20°42 . 24
25 | Other Diseases of the

8-92 i 21

Respiratory System . 5 45°82 . 25
26 | Mental, Psychoneurotic and
Personality Disorders < s > Io‘1r 26
27 | All Other Diseases # Bi 186-87 27
28 Total Admissions for
Diseases % . *56 | 1,575°82 | 1,217°95 28

29 | Injuries—N.E.A.
30 | Injuries—E.A. .

3°

31 Total Admissions for .
Injuries . : 31
32 Total Admissions : - |1,027°01 |x “ 1,364°95 32

* Any cases included in ‘All Other Diseases’.

Note: 194: 945 rates a are equivalent, being based on the known admissions for the first
nine mon: the year.

388 CASUALTIES AND MEDICAL STATISTICS

TABLE 124

South-East Asia Command (Indo-Burma Front)
Causes of Admissions to Hospitals, 1942-45. V.C.Os. and I.O0.Rs.
Annual Rates per 1,000 Strength

Source: A.F. A.31-B

E.A.R.
CAUSES 1943 1944 1945
1 | Common Cold 34°6 33°9 23°99 | 1
2 | Diarrhoea * 3 27°9 39°6 18°40 2
3 | Dysentery . 3 a 33°6 40°0 18-51 3
4 | Dengue Fever . og o4 rar 4
5 | Diphtheria . o2 oo 0°09 5
6 | Enteric Group of Fevers o-4 o's oz 0°23 6
7 | Infective Hepatitis a o's a‘1 12°3 14°67 7
8 | Malaria . 447°4 485-6 319°4 68-44 8
9 | Mumps 10°8 44 4°6 6-23 9
10 | Pneumonia 3's 2°3 3°65 | 10
11 | P.U.O. and N.Y.D. Fever 3 72°3 115°0 28-48 | 11
12 Sandlly Fever 1 S34 or 0°67 | 12
13 7 . ‘4 “9 27° 23°4 12°63 | 13
14 Smallpox 5 . 2 os 06 0:40 | 14
1§ | Tonsillitis . S a i) 3°5 3'0 3°44 1 15
16 | Tuberculosis 14 13 1°79 | 16
17 | Venereal Diseases 65°7 36°3 45°96 | 17
18 | Diseases of the Circulatory
System . 5 5°2 5 2:92 | 18
19 Diseases due to Disorders of
Nutrition . 2 018 | 19
20 | Diseases of the Ear, Nose
and Throat . : 13°55 | 20
21 | Diseases of the Eye . 14°32 | 21
22 | Diseases of the Skin (other
than Scabies) . 23°76 | a2
23 | Other Diseases of the
Digestive System 22°61 | 23
24 | Other Diseases of the
Respiratory Syetem . ar4r | 24
25 | Septic Conditions ; 29°47 | 25
26 | Mental, Psychoneurotic and
Personality Disorders 7°33 | 26
27 | All Other Diseases 81-99 | 27
28 Total Admissions for
Diseases ° ‘ 466-33 | 28
29 | Injuries—N.E.A. 57°73 | 29
30 | Injuries—E.A. 44°16 | 30
31 Total Admissions for
Injuries : : 10189 | 31
32 Total Admissions

* Any cases included in ‘All Other Diseases’.

Note: 1945 rates are equivalent, being based on the known admissions for the firet
nine months of the year.

THE ARMY MEDICAL SERVICES 389

TABLE 125

South-East Asia Command (Indo-Burma Front)
Causes of Admissions to Hospitals, 1942-45. Non-Combatants (Enrolled)
: Annual Rates per 1,000 Strength

Source: A.F. A.31-B

E.A.R.
CAUSES 1943 1944 1945
1 | Common Cold. ; 34°3 28:9 15°41 1
2 | Diarrhoea si 3 : 28-6 20° 9°44 2
3 | Dysentery . 2 i 4 34°8 28-3 10°04 3
4 | Dengue Fever. A ‘ 0-2 o's 0:29] 4
5 | Diphtheria . 4 x S or oo 0-04 s
6 | Enteric Group of Fevers o9 o's or o-14] 6
7 | Infective Hepatiss or o1 10°2 7°85 Z
8 | Malaria A 335°3 468-8 278-1 37°28
9 | Mumps — 74 10°4 73 6°57] 9
10 | Pneumonia 49 ¢ 4°3 3°99 | 10
11 | P.U.O. and N.Y.D. Fever 22°4 62°9 85-0 20°28 | 11
12 | Sandfty Fever oo o4 o'r 0-07 | 12
13 | Scabies 16-9 24°4 14°4 6-47 | 13
14 | Smallpox . : or o-9 9 0°39 | 14
15 | Tonsillitis . ‘ ‘ 2°3 3°0 9 1°67 | 15
16 | Tuberculosis : f 2-0 z ier 124 | 16
17 | Venereal Diseases “| a 62°4 86-8 38-1 31st | 17
18 | Diseases of the
Circulatory System . sr 4°5 3°3 1°33 | 18
19 | Diseases due to Disorders of
Nutrition . — 06 = oor | 19
20 | Diseases of the Ear, Nose
and Throat . 18-3 19°9 17°8 6-41 | 20
21 | Diseases of the E: * 10°! 18-1 10°4 8-19 | ar
22 | Diseases of the BE i (other
than Scabies) i 13°5 20°9 17°6 11°74 | 22
23 | Other Diseases of the
Digestive System. 18-3 37°6 28-6 11°79 | 23
24 | Other Diseases of the
Respiratory System . 36°9 4a'1 g2t1 14°83 | 24
25 | Septic Conditions 5 28-0 36-2 23°2 1e-2 25
26 | Mental, Psychoneurotic and
Personality Disorders 1:2 3°5 3°4 6-39 | 26
27 | All Other Diseases 116-2 1405 85-4 49°19 | 27
28 Total eden 1%)
Diseases 7762 ,082°8 742°9 278-85 | 28
29 | Injuries—N.E.A. 33°4 36°9 3o°1 26°32 | 29
30 | Injuries—E.A. . 1° 12 4 2°40 | 30
31 Total Admissions for
Injuries . 4 % 34°3 38-1 34°7 28-72 | 31

32 Total Admissions e 810°5 | 1,120°9 7715'S 307°S9 | 32

* Any cases included in ‘All Other Diseases’.

Note: 1945 rates are equivalent, being based on the known admissions for the first
nine months of the year.

390 CASUALTIES AND MEDICAL STATISTICS

TasLe 126
South-East Asia Command (Indo-Burma Front)
Admissions for Diseases, 1942-45
Crude Average Rates and Order of Precedence of Indtvidual Disease Among
(i) V.C.Os. and I.0.Rs. and (ii) N.Cs.(E.)

Source: A.F. A.31-B
Average Rates

DISEASES

Malaria. i
P.U.O. and N.Y.D. Fever -
Venereal Diseases . .

Dysentery is
Septic Conditions
Other Diseases of the Digestive

Other Diseases of the Respiratory
System te

Diseases of the Skin (other than
Scabies) . 7 .

Scabies

Diseases of the Ear, Nose and
Throat . A

Diseases of the Eye

Infective Hepacies

Mumps

Diseases of the Circulatory System

Mental, Psychoneurotic and
Personality Disorders

Tonsillitis J

Pneumonia

Tuberculosis

Lan el Fever

Enterke Group of Fevers

Sandfly Fever .

Diseases due to Disorders of
Nutrition

Diphtheria :
Other Diseases .

Average Total aeaeiont for
Diseases.

QF asa Su

RR Od VED

832-2

* Based on admissions for three years only.

THE ARMY MEDICAL SERVICES 391

TABLE 127

South-East Asia Command (Indo-Burma Front)
Causes of Admissions to Hospicals, 1948-45
W.A.CAL.) and ILM.N.

Source: A.F. A.31-B

CAUSES
1 | Common Cold I
2 | Diarrhoea 2
3 | Dysentery . 3
4 | Dengue Fever 4
5 | Diphtheria . 5
6 | Enteric Group of Fevers 6
z Infective Hepatitis 7
Malaria : a 8
9 | Mumps. 9
10 | Pneumonia 10
ar | P.U.O. and N.Y.D. Fever m1
12 | Sandfly Fever . 12
13 | Scabies 13
14 | Smallpox 14
15 | Tonsillitis 15
16 | Tuberculosis 16
17 | Venereal Diseases 17
18 | Diseases of the Circulatory
System 18
19 | Diseases due to Disorders of
Nutrition 19
20 | Diseases of the Ear, Nowe and
Throat 20
21 | Diseases of the Eye ar
22 | Diseases of the Be (other
than Scabies) 22
23 Other Diseases . of the
gestive System. 23
24 | Other Diseases of the
Respiratory System . 24
25 | Septic Conditions 25
26 | Mental, Psychoneurotic and
Personality Disorders 26
27 | All Other Diseases 3 27
28 Total Admissions for
Diseases F ‘ 28
29 | Injuries—N.E.A. 29
30 | Injuries—E.A. 30
31 Total Admissions for
Injuries 3 5 31
32 Total Admissions 96-67 176-28 32

= Se ee ee ee ee ee ee
Note: Rates for 1945 are equivalent, being based on the known admissions for the first
nine months of the year.

392 CASUALTIES AND MEDICAL STATISTICS

Tasie 128

South-East Asia Command (Indo-Burma Front)
Causes of Admissions to At 1942-45

All Indian T:
Source:A.F. A.31-B. Annual rates 1,000 Strength

CAUSES

Common Cold.
Diarrhoea :
Dysentery .
Dengue Fever
Diphtheria .

|

Enteric Group of Fevers
Infective Hepatitis
Malaria. :
Mumps

Pneumonia

11 | P.U.O. and N.Y.D. Fewee
12 | Sandfly Fever

13 | Scabies

14 | Small, :

15 | Tonsillitis .

16 | Tuberculosis Fs

17 | Venereal Diseases

18 | Diseases of the Circulatory
System .

19 Diseases due to Disorders of |
Nutrition _

20 | Diseases of the Ear, Nowe and
it. a

OO MID NAWDH

”

21 | Diseases of the E:
22 | Diseases of the Shin (other
than Scabies) c

23 | Other Diseases of the
Digestive System

24 | Septic Conditions

25 | Other Diseases of the
Respiratory System . 7

26 | Mental, Psychoneurotic and
Personality Disorders
27 | All Other Diseases 3

28 Total Admissions for
Diseases 2

29 | Injuries—N.E.A.
30 | Injuries—E.A.

Total Admissions for
Injuries ms

32 Total Admissions

* Any cases included in ‘All Other Diseases’.

COON A Udwne

Note: 1945 rates are equivalent, being based on the known admissions for the first

nine months of the year.

THE ARMY MEDICAL SERVICES 393

‘TABLE 129

South-East Asia Command (Indo-Burma Front)
Causes of Admissions to Hospitals, 1944 and 1945
West African Other Ranks

CAUSES 1944 1945
E.A.R. E.A.R.
1 Common Cold 6:83 6-71 1
2 Diarrhoea 7 28-97 12°96 2
3 Dysentery # & Me . 2 52°42 22°40 3
4 Dengue Fever . A 3 H 3. 0°48 o-2a1 4
5 Diphtheria j F : 3 ‘ +g 5 5
6 Enteric Group of Fevers 0°16 0°48 6
7 | Infective Hepatitis . . 20°61 oa 7
8 Malaria ss 3 E 4 % 38°84 10°4! 8
9 Mumps. S ‘ . Fs ‘ 1°38 2°52 9
10 Pneumonia ‘ * ‘ 13°96 23°44 10
W P.U.O. and N.Y.D. Fever 44°54 20°12 a4
12 Sandfly Fever 0°48 0°93 12
13. | Scabies 4-24 3°04 13
14 Small; : 3°20 rez 14
15 | Tonsillitis . 1-92 1-91 15
16 Tuberculosis a 0°52 0°65 16
7 Venereal Diseases u Zs go'os, 68-59 1
18 Diseases of the Circulatory System b 2°57 2°41 X
19 Diseases due to Disorders of Nutrition 2 0°04 o°13 19
20 | Diseases of the Ear, Nose and Throat 9°37 7°92 20
21 Diseases of the Eye ‘ 9°31 11°35 21
22 Diseases of the Skin (other than Scabies) ‘ 16-01 16°69 22
23 Other Diseases of the Digestive System : 22°84 1me3 23
24 Septic Conditions : 32°21 28°80 24
25 Other Diseases of the Respiratory System E 31°46 25°79 25
26 Mental, Esychoneuropic: and Pessonaliey
Disorders < . : 3°34 4°49 26
27 All Other Diseases : 5 7 < a 185°71 posers 27
28 Total Admissions for Diseases é : ; 621-46 402°20 28
29 Injuries—N.E.A. f a hs " . 34°22 36°03 29
jo Injuries—E.A. . a 2 3 < 15°74 37°90 jo
31 Total Admissions for Injuries é ; ; 49°97 73°92 31
32 Total Admissions 4 - - ¥, " 671-44 476°11 32

* Any cases included in ‘All Other Diseases’.

Note: The rates shown are equivalent, being based on the known admissions for the
last ten months in 1944 and the first nine months in 1945.

394 CASUALTIES AND MEDICAL STATISTICS

TABLE 130

South-East Asia Command (Indo-Burma Front)
Causes of Admissions to Hospitals, 1944 and 1945
East African O1 Ranks
Annual Rates per 1,000 Strength

Source: A.F. A.31-B.

-|

1 | Common Cold 1
2 | Diarrhoea 2
3 Dysentery 3
4 Dengue Fever. 4
5 Diphtheria . 5
6 | Enteric Group of Fevers 6
7 Infective Hepatitis 7
8 | Malaria 8
9 | Mumps. - 9
10 | Pneumonia 10
11 | P.U.O. and N.Y.D. Fever . D \ 7 : g 534
3x2 | Sandfly Fever. , . Ps ° 12
13 Scabies 5 is 3 S . _ 5 7 13
14 | Smallpox . : ‘ 5 ‘ a i : 14
1s | Tonsillitis . 5 d Q f : : 15
16 | Tuberculosis % . - : : 16
1 Venereal Diseases . ‘ 17
1 Diseases of the Circulatory System’ $ . 18
19 Diseases due to Disorders of Nutrition . 4 bd 19
20 Diseases of the Ear, Nose and Throat 7 . . 20
a Diseases of the Eye. : : 21
az | Diseases of the Skin (other than Scabies) : = 22
23 | Other Diseases of the Digestive System . : . 23
24 | Septic Conditions . . 24
25 Other Diseases of the Respiratory System . : 25
26 =| Mental, Psvenoneurotic: and Bereonality
Disorders , : . 26
27 =| All Other Diseases a ie < ‘ . . 27
28 Total Admissions for Diseases a ‘ : : 28
29 | Injuries—N.E.A. : : - ‘ : : 29
30 | Injuries—E.A. . 3 ‘ é : . 30
31 Total Admissions for Injuries . bs . “ 31
32 Total Admissions : . a : : 32

* Any cases included in ‘All Other Diseases’.

Note: The rates shown below are equivalent, being based on the known admissions
for the last seven months in 1944 and the first nine months in 1945.

THE ARMY MEDICAL SERVICES 395

‘TABLE 131

South-East Asia Command (Indo-Burma Front)
Causes of Admissions to Hospitals, 1942-45
4 ; Re Troops 7 in
te 1,000 St
Source: A.F. A.31-B serpanccant sa ibid

CAUSES 1942
1 | Common Cold . < : 13°66 I
2 | Diarrhoea : : . 29°14 2
3 | Dysentery . e x 4 59°14 3
4 | Dengue Fever . z . 11-13 4
5 | Diphtheria . Fi ‘ y o-19 5
6 | Enteric Group of Fevers 5 0°95 6
7 | Infective Heparits > % 1°86 z
8 | Malaria . : . 394°79
9 | Mumps. s : 7 7°42 9
10 | Pneumonia 5 - ? 3°17 10
11 | P.U.O. and N.Y.D. Fevers . 29°71 34
12 | Sandfly Fever. S o-8r 12
13 | Scabies r iS i : 13°81 13
14 | Smallpox . e é . 0°24 14
15 | Tonsillitis . % es by 5°62 15
16 | Tuberculosis y ‘ - 1°82 16
17 | Venereal Diseases 2 50°20 17
18 | Diseases of the Circulatory
System . 5°29 18
19 Diseases due to Disorders of”
Nutrition 0-10 19
20 | Diseases of the Ear, Nose and
Throat . ‘ : f 16°39 20
21 | Diseases of the Eye z 7 8-92 ar
22 | Diseases of the Skin (othes
than Scabies) . . 19°55 22
23 | Other Diseases of the
Digestive System a 31°30 23
24 | Septic Conditions i a 31°52 24
25 | Other Diseases of the
Respiratory System . F 34°40 25
26 | Mental, Psychoneurotic and
Personality Disorders 2 1°76 26
27 | All Other Diseases . A 11164 27
28 Total Admissions for
Diseases f : ~ | 884-53 28
29 | Injuries—N.E.A. & F 35°61 29
30 | Injuries—E.A. . 5 ‘ 6°18 30
31 Total Admissions for
Injuries : 41°79 31
32 Total Admissions . ¢ 926°32 32

* Any cases included in ‘All Other Diseases.’

Note: 1945 rates are equivalent, being based on the known admissions for the
first nine months of the year.

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396 CASUALTIES AND MEDICAL STATISTICS

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397

THE ARMY MEDICAL SERVICES

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398 CASUALTIES AND MEDICAL STATISTICS

TABLE 133

South-East Asia Command (Indo-Burma Front)
Deaths in Hospitals, 1942-45
By Categories of Troops
Annual Rates per 1,000 Strength
Source: A.F. A.31-B

CAUSES
British Officers
Diseases and N.E.A. Injuries,
E.A. Injuries

Totals
British Other Ranks
Diseases and N.E.A. Tnyunes:
E.A. Injuries
Totals

V.C.Os. and I.0.Rs.
Diseases and N.E.A. Injuries

E.A, Injuries
Totals
N.Cs.(E.)
Diseases and N.E.A. Injuries
E.A. Injuries
Totals

W.A.C.(1.) and I.M.N.S.
Diseases and N.E.A. Injuries

E.A. Injuries ‘ .
Totals
All Indian Troops
Diseases and N.E.A. Injuries
E.A. Injuries .
Totals
W.A.O.Rs.
Diseases and N.E.A. Enjuries
E.A. Injuries
Totals
E.A.O.Rs.
Diseases and N.E.A. nitirice:
E.A. Injuries

Totals

THE ARMY MEDICAL SERVICES

TABLE 134

South-East Asia Command (Indo-Burma Front)
Admissions to Hospitals for Diseases, 1942-45
Comparative Rates B.O.Rs. and V.C.Os. and I.0.Rs.

Source: A.F. A.31-B

OCW A WVFWnH

Common Cold .
Diarrhoea i
Dysentery .
Dengue Fever .
Diphtheria a

Enteric Group of Fevers
Infective Hepatitis
Malaria.

Mumps

Pneumonia

P.U.O. and N.Y.D. Fever
Sandfly Fever ‘3 :
Scabies

Smallpox .

Tuberculosis

Venereal Diseases .

Diseases of the Circulatory System
Diseases due to Disorders of Nutrition .
Diseases of the Ear, Nose and Throat
Diseases of the Eye . ee . .

Diseases of the Skin (Other than Scabies)

Other Diseases of the Digestive System

Septic Conditions : ey
Other Diseases of the Respiratory “System : 3
Mental, Psychoneurotic and Personality Disorders .

All Other Diseases. 3
Total Admissions for Diseases .

399

COOMA utwne

“

yoo CASUALTIES AND MEDICAL STATISTICS

OO MIR Ubon

TABLE 135

South-East Asia Command (Indo-Burma Front)
Admissions to Hospitals for Diseases, 1944-45
Comparative Rates Other Ranks

Source: A.F. A.31-B

DISEASES

Common Cold . 5 .
Diarrhoea : 2 °
Dysentery

Dengue Fever

Diphtheria

Enteric Group of Fevers.
Infective Hepatitis

Malaria

Mumps a
Pneumonia :

P.U.O. and N.Y.D. Fever.

Sandfly Fever
Scabies
Smallpox .
Tuberculosis

Venereal Diseases

Diseases of the Circulatory "
System

Diseases due to Disorders of
Nutrition : .

Diseases of she Ear, Nose
and :

Diseases of the Eye

Diseases of the Skin
(Other than Scabies) .
Other Diseases of the
Digestive System.
Septic Conditions
Other Diseases of the
Respiratory System
Mental, Psychoneurotic and.
Personality Disorders
All Other Diseases

Total Admissions for Diseases

OO RDNYUAD Ubon

(ii) Ceylon

BRITISH TROOPS

BRITISH OFFICERS

In Table 136 are presented the admission rates of British Officers for

the years 1942 to 1945. They include not only those officers on the
strength of British Units, but also those who were attached to Indian,
Ceylonese and East African Units.

THE ARMY MEDICAL SERVICES 401

Admissions for diseases were highest in 1942 and lowest in 1945, the
rate for which year was slightly over half that for 1942. In 1943, admis-
sions were three-quarters those of 1942 and were almost equal to those
in 1944. Rates were 857 in 1942, 632 in 1943, 623 in 1944 and 443 in
1945. Admissions for injuries were also highest in 1942 at 75 per 1,000.
The second highest rate occurred in 1944 at 51, followed by 42 in 1943
and 39 in 1945. The majority of injuries were sustained other than by
enemy action. Total admissions were 993 per 1,000 in 1942, 674 in 1943
and 1944, and 482 in 1945.

Of those diseases noted in the table, MALARIA caused most admissions,
except in 1945, when Diseases of the SKIN took pride of place. Malaria
was responsible for admission rates at 135 in 1942 and 132 in 1943.
This was followed by a decline of nearly fifty per cent. to 71 in 1944 and
a similar fall to 33 in the ensuing year. Rates for P.U.O. and N.Y.D.
FEVER are not known for 1942 and 1943, but in 1944 and 1945 they were
58 and 29.

Figures relating to Diseases of the skIN (other than Scabies) are also
not available for 1942 and 1943. Rates for the succeeding years were 43
and 49. DENGUE FEVER was responsible for the high admission rate of
112 per 1,000 in 1942. This was decreased by one-half in 1943 and
1944 to 60 and 58 respectively and, in 1945, to the low rate of 1o.
SEPTIC CONDITIONS which registered the high rate of 86 in 1942 fell
considerably to 18 in 1945 with 28 and 31 in the intervening years.

A trend similar to that exhibited by Septic Conditions was witnessed
in Other Diseases of the DIGESTIVE SYSTEM which recorded rates of 73
in 1942, 42 in 1943, 46 in 1944 and 30 in 1945. The rates for DYSENTERY
were fairly constant, ranging from 27 in 1944 and 1945 to 29 in 1943.
DIARRHOEA showed a decline of 10 per 1,000 from the highest rate of
27 in 1944 to 17 in 1945. Other rates were 26 in 1942 and 20 in 1943.

Admissions for TONSILLITIS were 23 per 1,000 in 1942. In the following
year they declined by fifty per cent. to 12 but rose to 15 in 1944 and
again to 19 in 1945. INFECTIVE HEPATITIS caused rates at 24 per 1,000 in
1942 and § in 1943. This was followed by an increase to 13 in 1944 with
a decline by almost fifty per cent. to 7 in 1945. Admissions for COMMON
COLD were relatively high at rates which varied from 20 in 1942 to 12
in 1943. They increased to 14 in 1944 and to 16 in the following year.

Other Diseases of the RESPIRATORY SYSTEM registered 9 admissions per
1,000 officers in 1942. This rate declined to 2, then rose to a peak rate
of 19 in 1944 and subsided in 1945 to slightly above the 1942 rate to 10
per 1,000. DIPHTHERIA recorded the comparatively high rate of 7 in
1942. By 1944 it had declined to 3 and in the following year was 0-5
per 1,000.

VENEREAL DISEASES produced rates of g in 1942, 7 in 1943, 17 in 1944
and 9g in 1945. Rates for Diseases of the EYE fluctuated from 7 in 1942

402 CASUALTIES AND MEDICAL STATISTICS

to 2 in 1943, rose to 8 in 1944 and fell to 4 in 1945. Admissions for
MENTAL, PSYCHONEUROTIC and PERSONALITY Disorders also fluctuated
from 6 in 1942 to 3 in the following year, then to 6 in 1944 and finally
to 9 in 1945. In 1942 the rate for TUBERCULOSIS was 2 per 1,000. This
was reduced to 1-3 in 1943 and again to o-5 in both 1944 and 1945.

There were no admissions over the period for SMALLPOX, SANDFLY
FEVER or for Diseases due to Disorders of NUTRITION.

BRITISH OTHER RANKS

Table 137 records the rates of admissions to hospitals of B.O.Rs.
Admissions for diseases only were, in general, somewhat higher than
those for British Officers. In 1942, 1943 and 1945, they were some thirty
per cent. higher. In 1944, however, the rate was three per cent. lower.
Rates, which declined each year, were 1,094 in 1942, 813 in 1943, 602 in
1944 and 584 in 1945. Admission rates for Injuries were also higher
than those for Officers, except in 1942, at 72, 51, 55 and 47 per 1,000,
respectively. Total admission rates were 1,166 in 1942, 865 in 1943,
658 in 1944 and 631 in 1945.

As with officers, MALARIA, individually, caused more admissions than
any other disease. The rate in 1942 was 278; it fell slightly to 254 in
the following year. By 1944 it had declined by two-thirds to 82 and in
1945 there was a further fall to 36. The 1945 rate was approximately
one-eighth that of 1942 and the decline was much steeper than the one
experienced by Officers. Rates for P.U.O. and N.Y.D. FEvER are not
available for the first two years but were 44 in 1944 and 24 in 1945.

Second in importance to Malaria, in so far as numbers admitted are
concerned, were VENEREAL DISEASES. The high rate of 113 per 1,000 in
1942 was followed by a decline of forty-five per cent. in 1943 to 63.
There was a further fall during the following year when the rate was 47
but, in 1945, admissions increased to a rate only slightly lower than that
of 1943 at 62 per 1,000. The rate of 113 in 1942 was the highest re-
corded by any class of personnel in this area during the four years.

DENGUE FEVER was responsible for some high admission rates which, on
the whole, were lower than those registered by Officers. It was only in
1945 that the rate for Officers was lower. Rates for B.O.Rs. were 79
(as against 112 for Officers) in 1942, 54 (60) in 1943, 53 (58) in 1944
and 20 (10) in 1945. SEPTIC CONDITIONS also caused some high rates, as
with Officers, particularly in 1942, when the rate was 88 per 1,000.
This was followed by 32 in 1943, 29 in 1944 and 32 in 1945.

Admissions for Other Diseases of the DIGESTIVE SYSTEM, which
followed Septic Conditions in importance, were 42 in 1942, and 4o in
1943 with 33 and 31 in the two ensuing years. Admissions for DysEN-
TERY and DIARRHOEA were much lower than on the Indo-Burma Front.
Rates for the former ranged from between 25 (in 1943) and 29 (1944

THE ARMY MEDICAL SERVICES 403

and 1945) while those for Diarrhoea were 35 in 1942, 15 in 1943, 17 in
1944 and 21 in 1945.

TONSILLITIS rates registered by British Officers in 1943 were approxi-
mately one half the 1942 rate. This was duplicated by B.O.Rs. whose
rates for the two years were 33 and 15. A further decline occurred in
1944 to 13, but in 1945 there was a slight rise to 16 per 1,000. COMMON
COLD recorded an admission rate of 30 in 1942 as against 20 for Officers.
This decreased each year until by 1945 the rate was 8 per 1,000. The
trend was rather different to that of Officers which showed successive
increases in the last two years following a decline in 1943. Other
Diseases of the RESPIRATORY SYSTEM caused admissions at rates of 8 in
1942 and 3 in 1943. In the two following years admissions were much
heavier at 16 in 1914 and 14 in 1945.

Admissions for Diseases of the EYE fell from 11 to 7 in 1943 and to 6
in 1944 but increased to 10 in 1945. The rates for INFECTIVE HEPATITIS,
contrary to those recorded on the Indo- Burma Front, were fairly stable
at between 8 and 10 per 1,000 except in 1943, when the rate was 6. In
general they were lower than those for Officers.

The rates for scaBIES varied between 4 and 7. Those for Diseases of the
SKIN rose from 48 in 1944 to 69 in 1945. The rates for the first two years
are not available. There were no admissions for diseases due to Dis-
orders of NUTRITION during the first three years, none for SMALLPOX in
1942 and 1943 or from MUMPS in 1943.

ALL BRITISH TROOPS

Table 138 gives the Annual rates of admissions to hospitals for All
British Troops. As the strength of Other Ranks was greatly in excess
of that of Officers, the rates tend to follow those of B.O.Rs. in Table 137.

Compared with the rates for All British Troops on the Indo-Burma
Front, admissions for diseases were, in general, not so heavy, in spite of
the 1942 rates which, in Ceylon, were greater by go per 1,000. On the
Indo-Burma Front admissions in 1943 had risen by nearly 600 per
1,000 to a peak rate of 1,576. The same year, in Ceylon, witnessed a
decline of admissions by over one quarter those of the previous year.
In 1944 the difference in rates was some 600 per 1,000, but in 1945 was
only 130. In Ceylon, the 1945 rate was fifty-one per cent. that of 1942,
while on the Indo-Burma Front, it was seventy per cent. If, however,
the 1945 rates are compared with admissions in peak years, the figures
are fifty-one and forty-four per cent. respectively.

It is perhaps worthy of mention that success in the fight against
MALARIA, among British Troops at least, appeared one year earlier in
Ceylon where the rate in 1943 of 238 was followed by 80 in 1944, a
reduction of sixty-six per cent. The decline of admissions in 1944 on
the Indo-Burma Front was thirty-five per cent. The overall decline in

14CMS

404 CASUALTIES AND MEDICAL STATISTICS

Ceylon was nearly ninety per cent., while that on the Indo-Burma Front
was under seventy per cent. Annual rates were lower in Ceylon being
267 (as compared with 327 on the Indo-Burma Front) in 1942, 238
(560) in 1943, 80 (364) in 1944 and 36 (108) in 1945.

Admissions on account of DIARRHOEA and DYSENTERY were much less
in Ceylon but rates for DENGUE FEVER were considerably in excess. On
the Indo-Burma Front, admissions for INFECTIVE HEPATITIS increased
year by year from 6 in 1942 to 29 per 1,000 in 1945. In Ceylon, rates
varied from 6 to 10 with the second lowest rate in 1945.

Rates for SMALLPOX were less that those recorded on the Indo-Burma
Front, there being none in 1942 or 1943, while the rates for the following
years at 0.16 and o-11 per 1,000 compared with 0-47 and 0-93. TONSIL-
LiTIs caused higher rates of admission in Ceylon, especially in 1942
as did SEPTIC CONDITIONS with 89 per 1,000 as against 24. During the
other years, rates varied much less.

Perhaps the greatest differences in rates were registered by Other
Diseases of the RESPIRATORY SYSTEM. In Ceylon, the rates were 8 per
1,000 in 1942, 4 in 1943, 0°16 in 1944 and 13 in 1945, while on the
Indo-Burma Front they were 52, 64, 46 and 51 respectively. Although,
in 1942, the rate of admissions in Ceylon on account of MENTAL, PSYCHO-
NEUROTIC and PERSONALITY DISORDERS was twice that on the Indo-Burma
Front, by 1945 the position was reversed and the rate in Ceylon was 10,
as compared with 21 per 1,000.

Summary

Rates of admission to hospitals were, generally, less in Ceylon than
on the Indo-Burma Front. Among individual diseases, lower rates
were recorded for Diarrhoea, Dysentery, Infective Hepatitis, Smallpox
and, particularly, Malaria. Admission rates were higher for Tonsillitis,
Septic Conditions and, more especially, for Dengue Fever.

INDIAN TROOPS

INDIAN OFFICERS

Table 139 records the admission rates of Indian Officers to hospitals
in Ceylon. As information for 1945 is unobtainable, only those rates for
the three years 1942 to 1944 have been recorded.

There were very few Indian Officers stationed in Ceylon. Because of
this and for reasons which have already been discussed, a comparison
between Indian Officer rates and those of other classes of troops is
invalid as is, indeed, a comparison between the annual rates among
those Officers. The purpose of including the table is to make the statis-
tical survey of morbidity in this area as complete as possible.

THE ARMY MEDICAL SERVICES 405

VICEROY’S COMMISSIONED OFFICERS AND INDIAN OTHER RANKS

Admission rates of V.C.Os. and I.0.Rs. are shown in Table 140.
As with British Troops, a successive annual decrease was experienced,
Rates for disease were 867 in 1942, 703 in 1943, 614 in 1944 and 464 in
1945. The overall decline was forty-six per cent. Injuries accounted
for rates at 66, 48, 52 and 43 per 1,000 respectively.

Of individual diseases, MALARIA accounted for the highest rates with
195 in 1942, followed by 189 in 1943 and 156 in 1944. In the following
year, the rate declined to one third the 1942 rate at 65. Admission rates
for P.U.O. and N.Y.D. FEvER are available only for 1944 and 1945
when they were 67 and 35.

Next to Malaria in order of numerical importance were admissions
for VENEREAL DISEASES. There was comparatively little variation in the
rates which decreased annually from 47 in 1942 to 37 in 1945. SEPTIC
CONDITIONS were also responsible for high rates of admissions at 72 per
1,000 in 1942. Successive declines in the two following years were
recorded at rates of 44 and 22 but in 1945 aslight rise brought admissions
to 25 per 1,000. Other Diseases of the DIGESTIVE SYSTEM registered rates
of 50 in 1942, 28 in both 1943 and 1945, and 32 in 1944. The rates for
DYSENTERY were lower at 19, 23, 25 and 19 respectively, while those for
DIARRHOEA were, on the average, still lower at 31, 22, 14 and 11 per
1,000.

Admissions for Diseases of the EAR, NOSE and THROAT are known only
for 1944 and 1945, and were comparatively high at 25 and 28 per 1,000.
Although the rates for Other Diseases of the RESPIRATORY SYSTEM
decreased in 1943 from 17 to 7, they rose in 1944 to 27 per 1,000 and,
in 1945, to 28. Admissions for Diseases of the EYE were 23 in 1942.
They declined in 1943 to 16 and again in the following year to 13, but
increased to 19 in 1945.

COMMON COLD recorded comparatively low rates in the second and
fourth years of the period with 9 and 8 in 1943 and 1945 against 18 and
26 per 1,000 in 1942 and 1944. Admissions for SCABIES were consistent
at 16 per 1,000 except in 1944 when the rate was 10. The rate for
Diseases of the SKIN in 1944 and 1945 was 21 while those for the previous
years are not available. In spite of a rise from 11 in 1943 to 16 in 1944, a
large decrease in admission rates over the four years was recorded by
DENGUE FEVER from 17 in 1942 to 4 in 1945. The rates for INFECTIVE
HEPATITIS ranged from 4 to 7 and those for TONSILLITIS were even less
varied at from 4 to 5.

The high rate of 10 per 1,000 was recorded for TUBERCULOSIS in 1943,
following a rate of 4 in the pzevious year. Those in the ensuing years
were 1-70 and 1-19. A similar trend, but of lesser magnitude was ex-
perienced among N.Cs.(E.) at 3, 7, 1:16 and 0-60 per 1,000 over the
four years.

406 CASUALTIES AND MEDICAL STATISTICS

MENTAL, PSYCHONEUROTIC and PERSONALITY DISORDERS were respon-
sible for rates which increased from 3 per 1,000 in 1942 and 1943, to
5 in 1944 and 6 in 1945. Admissions for MUMPS were comparatively
high in 1942 and 1945 at 2-12 and 2-65 with 0-78 and 1-41 in 1943 and
1945.

Of the other diseases noted in the table with low rates, admissions for
diseases due to Disorders of NUTRITION were recorded only in 1944 at
1°05 per 1,000; there were no admissions in 1945 for SANDFLY FEVER or
for the ENTERIC Group of Fevers and none for DIPHTHERIA in 1943.

NON-COMBATANTS (ENROLLED)

In presenting the rates of admissions to hospitals of N.Cs.(E.) in
Table 141 it must be mentioned that the figures include some labourers,
civilians from Southern India, mainly Travancore State, employed by
the Government of India in clearing and levelling ground for air-strips,
etc. The number included is not known, but it is certain that there
were not many and insufficient to affect the rates cited to any marked
degree. The figures in the table then, to all intents and purposes, reflect
the morbidity state among N.Cs.(E.).

Rates for diseases decreased annually from 778 in 1942, to 667 in
1943 and from 361 in 1944 to 209 in 1945. These were lower than the
rates for I.0.Rs. by from 100 in 1942 to 250 in 1945. The overall rate
of decrease from 1942 to 1945 was seventy-three per cent. as against
forty-six per cent. for I.0.Rs. Injury rates which were predominantly
N.E.A., varied from 39 in 1942 to 14 in 1945.

As with B.O.Rs. and I.0.Rs., MALARIA was, individually, responsible
for more admissions than any other disease and followed the normal
trend of successive annual declines. Rates were 210, 156, 97 and 61 per
1,000. The 1942 rate was slightly higher than that for I.O.Rs. but other
rates were less, although in 1945 the difference was only 3 per 1,000.
The fall in 1944 was thirty-eight per cent., compared with eighteen
per cent. among I.0.Rs., but in 1945 the decline among I.O.Rs. was
greater by twenty per cent. Admissions for P.U.O. and N.Y.D. Fever,
known only for 1944 and 1945 were 37 and 22 per 1,000.

Following Malaria in numerical importance were admissions for
VENEREAL DISEASES. The rates were higher than those for I.0.Rs. in
1942 and 1943, but lower in the two ensuing years. They were 72 (as
against 47 for I.0.Rs.) in 1942, 56 (44) in 1943, 21 (40) in 1944 and the
extremely low rate of 9 (37) in 1945.

Admissions for Other Diseases of the DIGESTIVE SYSTEM increased by
over fifty per cent. in 1943, from 32 to 51. In 1944 they declined to
17 and by 1945 were only g per 1,000. The rates for DIARRHOEA followed
the general trend, in that they declined annually, and were 21, 11, 8 and
4 respectively. Those for DYSENTERY, however, increased from 10 in

THE ARMY MEDICAL SERVICES 407

1942 to 13 in 1943 and to 19 in the following year, before falling to 10
in 1945. In all these diseases the rates for I.O.Rs. were somewhat higher.

In 1942 and 1943, admissions for DENGUE FEVER were heavier among
N.Cs.(E.) when rates of 25 and 13 were recorded, as against 17 and 11
for I.0.Rs. During 1944 and 1945, however, admissions of the former
were 6 and 1 in contrast to 16 and 4 for I.0.Rs. Admissions for COMMON
COLD rose in 1943 by nearly fifty per cent., from 13 to 18, declined in
1944 to 11 and, in 1945, to 3 per 1,000. In contrast, admissions among
1.0.Rs. fell in 1943 by fifty per cent., rose in 1944 and in 1945 decreased
to approximately the 1943 rate.

Diseases of the EYE recorded an admission rate of 17 in 1942, which
declined by one third to 11 in the following year and to 5 per 1,000 in
1944 and 1945. The corresponding rates for I.0.Rs. were higher at 23,
16, 13 and 19 respectively.

SCABIES recorded admission rates which were approximately half
those for I.0.Rs. and which ranged between 6 and 10 per 1,000, while
diseases of the SkIN (during the two years for which figures are available)
were g and 6.

The rate for TUBERCULOSIS was unusually high in 1943 at 7 per 1,000.
Other rates were 3 in 1942, 1-16 in 1944 and 0-60 in 1945. The trend
of admissions on account of MENTAL, PSYCHONEUROTIC and PERSONALITY
DISORDERS was different from that recorded by I.O.Rs. Whereas rates for
the latter increased annually, those for N.Cs.(E.) increased only in 1943
(from 1-5 to 4) and decreased to 3 and 2 in the following years. The
rates for INFECTIVE HEPATITIS, which were approximately one-half of
those for I.O.Rs., showed no particular trend, and ranged between 2 and
4, while those for TONSILLITIS were lower at between 1 and 3 and were
also less than those reported for I.0.Rs.

Of other diseases whose admission rates were relatively low, there
were very few cases of SMALLPOX recorded in 1942, 1944 or 1945 and
None in 1943; there were no admissions for DIPHTHERIA in 1945, of
the ENTERIC Group of FEVERS in 1942, or for Disorders of NUTRITION in

1942 and 1943.

INDIAN MILITARY NURSING SERVICE

Table 142 records the annual rates of known admissions to hospitals
in Ceylon of members of the Indian Military Nursing Service.

The strength of the I.M.N.S. in Ceylon during the years 1942 to
1945 was particularly small and care must be taken in endeavouring to
compare morbidity rates of this class of personnel with another, all the
more so as much information is missing, especially in 1944 and 1945.
The missing information, however, does not affect the rates for total
admissions for disease.

408 CASUALTIES AND MEDICAL STATISTICS

ALL INDIAN TROOPS

The admission rates for All Indian Troops are recorded in Table 143.
Admission rates and trends tend to follow, in general, those of V.C.Os.
and 1.0.Rs., who were the predominating numerical component of
Indian Troops.

Compared with the rates for this class of troops serving on the Indo-
Burma Front, admissions for diseases only were slightly higher in 1942
(by 14 per 1,000) and in 1945 (by 43 per 1,000). In 1943 and 1944,
however, those in Ceylon were lower by 372 and 258 per 1,000 res-
pectively. Compared with 1942, the decrease in Ceylon by 1945 was
forty-six per cent. as against fifty per cent. on the Indo-Burma Front.
If, however, the peak year of admissions is taken for comparison, the
decline on the Indo-Burma Front is even more striking at sixty-one
per cent. as against forty-six per cent. in Ceylon. Admissions for In-
juries were less in Ceylon. That this is due to the much lower rate on
account of injuries sustained through Enemy Action is offset by the
higher rates, in Ceylon, of N.E.A. injuries by, on the average, 8 per
1,000.

Rates for MALARIA were, in general, much higher on the Indo-Burma
Front. In 1945, however, the rate in Ceylon was 4 per 1,000 more. The
1945 rate in Ceylon was roughly one-third that in 1942 as against
approximately one-seventh on the Indo-Burma Front.

Apart from 1943, when admissions for VENEREAL DISEASES on the
Indo-Burma Front increased from 45 to 71, rates differed but little.
In Ceylon they ranged from 37 to 46 as against 37 to 45. Admissions on
account of SEPTIC CONDITIONS were higher in Ceylon, particularly in
1942, when the rate was 71 as compared with 34. Apart from this
admissions in Ceylon varied from 22 to 44 and, on the Indo-Burma
Front, from 20 to 35 per 1,000.

Other Diseases of the DIGESTIVE SYSTEM were also higher in 1942 at
50 as compared with 21. In 1943 and 1944 rates were twenty-five and
ten per cent. lower but in 1945 were again higher by thirty per cent.
Rates for DIARRHOEA and DYSENTERY were lower in Ceylon by twenty-
three and thirty-eight per cent. respectively. Admissions on account of
Other Diseases of the RESPIRATORY SYSTEM fluctuated between 7 in 1943
and 28 in 1945. Except in 1945 when they were slightly higher, rates
were, in general, much lower in Ceylon and differences ranged from
31 in 1943 to I in 1944.

Diseases of the EYE produced rates which, in general, were higher in
Ceylon. In 1942 the rate was 23 (compared with 10 on the Indo-Burma
Front), in 1943 it was 16 (19), in 1944 it was 13 (13) and 19 (13) in 1945.
Admissions for COMMON COLD were less in Ceylon by, on the average,
10 per 1,000. The greatest differences in rate occurred in 1943 and
1945 when rates in Ceylon were g and 8, while those on the Indo-Burma

THE ARMY MEDICAL SERVICES 409

Front were 34 and 22 respectively. Rates for SCABIES were also slightly
lower.

DENGUE FEVER produced rates which were considerably higher in
Ceylon. Whereas rates on the Indo-Burma Front varied from 2-20 in
1942 to 0°99 in 1945, those in Ceylon ranged from 17 to 4 per 1,000.
Admissions for TONSILLITIS were also higher in Ceylon, but differences
in rates much less. The highest rate of admission was 5-4 as against 3-4
on the Indo-Burma Front. INFECTIVE HEPATITIS was responsible for
rates which, on the Indo-Burma Front, rose from 0-57 in 1942 to 13 in
1945. In Ceylon rates were highest at 7 in 1942, lowest at 4 in 1943
while in 1944 and 1945 they were slightly under 6 per 1,000.

Apart from 1944 and 1945 when there was little difference in the
rates, admissions for TUBERCULOSIS were higher in Ceylon, particularly
in 1943 when the rate was extremely high at 9-92 per 1,000. In that
year the rates for both I.O.Rs. and N.Cs.(E.) were unprecedented.
MENTAL, PSYCHONEUROTIC and PERSONALITY DISORDERS were responsible
for admissions which rose from 2:6 in 1942 to 5-9 in 1944 as compared
with those on the Indo-Burma Front which increased from 1-4 to 7:1.

mumps caused less admissions in Ceylon with rates recorded at 0-78
to 2-65 as against 5-31 to 9-96. Admissions for diseases of the cIRCU-
LATORY SYSTEM were also considerably less, except in 1944 when the
rates were almost identical. Apart from 1944, rates varied from 0-13 to
0:77 as against 2°52 to 5:19 on the Indo-Burma Front.

Summary

Indian Troops were, in general, healthier in Ceylon than on the Indo-
Burma Front. Of individual diseases, there were less admissions in
Ceylon for Malaria, Diarrhoea, Dysentery, Common Cold, Infective
Hepatitis, Diseases of the Circulatory System and Other Diseases of the
Respiratory System. Higher admission rates were registered in Ceylon
by Diseases of the Eye, Tonsillitis and, in particular, Dengue Fever.

EAST AFRICAN TROOPS

EAST AFRICAN OTHER RANKS

East African Units were stationed in Ceylon from 1944 and rates of
admissions in hospitals for 1944 and 1945 are presented in Table 144.
As on the Indo-Burma Front, admissions of British Officers, Warrant
Officers and N.C.Os. attached to these units have been excluded
from this table and incorporated in their own tabulations. Admissions

410 CASUALTIES AND MEDICAL STATISTICS

for Diseases were at the rates of 411 in 1944 and 388 per 1,000 in 1945.
Those for Injuries were 34 and 46 respectively.

The highest rate of admissions was caused by VENEREAL DISEASES at
rates of 79 and 92 per 1,000. This was exceptional in that, for all other
classes of male troops, MALARIA took pride of place as causing the great-
est number of admissions. Indeed, Malaria, among this class of troops
was comparatively low at fifth place in the order of admissions at only
19 in 1944 and 14 in 1945.

After Venereal Diseases in numerical importance, DYSENTERY was
responsible for admission rates of 37 and 17 and Other Diseases of the
RESPIRATORY SYSTEM at 31 and 19. The rates for P.U.O. and N.Y.D.
FEVER varied but little at 19 and 21. Admissions for Diseases of the EAR,
NOSE and THROAT increased from 12 to 16 and Diseases of the EYE from
7 to 16, while those for COMMON COLD and SEPTIC CONDITIONS decreased
from 16 to 11 and from 17 to 10 respectively.

Other diseases for which admissions increased in 1945 were:

Other Diseases of the DIGESTIVESYSTEM from 7 to13 per 1,000
MENTAL, PSYCHONEUROTIC and

PERSONALITY DISORDERS from 3:2 to 7-1 per 1,000
INFECTIVE HEPATITIS from 2-1 to 4-3 per 1,000
SANDFLY FEVER from 0-65 to 2-51 per 1,000

Admissions for the following diseases decreased in 1945:

DIARRHOEA from 17 to § per 1,000
Diseases of the SKIN from 12 to 8 per 1,000
Diseases of the CIRCULATORY SYSTEM from 5 to 2 _ per 1,000
TONSILLITIS from 4 to 3 per 1,000
DENGUE FEVER from 3:1 to 0-9 per 1,000
SCABIES from 1-8 to 0-g per 1,000

In 1944 there were no admissions for Disorders of NUTRITION and in
1945 none for DIPHTHERIA, MUMPS, SMALLPOX or TUBERCULOSIS.

Compared with the E.A.O.Rs. on the Indo-Burma Front, admissions
for diseases were forty-four per cent. lower in 1944 and nine per cent.
lower in 1945.

Admissions for Malaria were less in Ceylon in 1944 where the rate
was 1g per 1,000 compared with 86 on the Indo-Burma Front, but in
the following year there was but little difference in the rates. The rates
for Dysentery were also higher on the Indo-Burma Front at four times
in 1944 and three times in 1945. P.U.O. and N.Y.D. Fever on the Indo-
Burma Front was over five times the Ceylon rate in 1944, but in 1945
was 5 per 1,000 less.

On the other hand, admissions for Venereal Diseases were higher in
Ceylon by 27 per 1,000 in 1944 and ro in 1945.

THE ARMY MEDICAL SERVICES 411
CEYLONESE TROOPS

CEYLONESE OFFICERS

Table 145 records the annual admission rates for Ceylonese Officers.
The strength of these officers was comparatively small and care should
be taken in drawing conclusions when comparing these rates with those
of other classes of troops. Admissions for diseases only were highest in
1944 at 387 per 1,000, as were those for Injuries at 57.

MALARIA was responsible for more admissions than any other disease
at an average rate of 55 per 1,000. This was followed by Other Diseases
of the DIGESTIVE SYSTEM at approximately one-half the Malaria rates.
COMMON COLD produced rates at 22 in 1944 and 14 in 1945.

Other diseases for which admissions decreased in 1945 were:

P.U.O. and N.Y.D. FEVER from 35 in1944to14 in 1945
SEPTIC CONDITIONS from io inig44to § in 1945
INFECTIVE HEPATITIS from 8 inig44to 5 in 1945
TUBERCULOSIS from 3:38 in 1944 to 1-57 in 1945

Increases in admissions were recorded by:
Diseases of the EAR, NOSE and

THROAT from 14 in 1944to17 ~— in 1945
Other Diseases of the

RESPIRATORY SYSTEM from 16 =in1944to19 in 1945
DIARRHOEA from 10 = in 1944 to 13s in 1945

CEYLONESE OTHER RANKS

Annual rates of admissions to hospitals in respect of Ceylonese Other
Ranks are recorded in Table 146. Admissions on account of diseases
declined annuallyfrom 868 in 1943 to 771 in 1944 and to 618 in 1945.
The decrease in 1944 was just over ten per cent. of the 1943 rate and
that in 1945 one-fifth of the previous year. Admissions for Injuries,
mainly N.E.A., varied from 41 to 48 per 1,000.

As with Officers, the largest number of admissions was caused by
MALARIA. The high rate of 215 in 1943 was exceeded only by British
Other Ranks at 278 with Non-Combatants (Enrolled) a close third with
210. A decline of one-third to 144 was recorded in 1943 and a further
fall in 1945 took the rate to 109 per 1,000. Rates for P.U.O. and N.Y.D.
FEVER were 71 in 1944 and 33 in 1945.

Admission rates for COMMON COLD were surprisingly high at 82 in
1943, 90 in 1944 and 81 in 1945, as were those of Other Diseases of the
RESPIRATORY SYSTEM at 29, 42 and 35 per 1,000 respectively. Other
diseases of the DIGESTIVE SYSTEM caused admissions at rates of 40 in
1943, 42 in 1944 and 39 in 1945.

14CMS*

412 CASUALTIES AND MEDICAL STATISTICS

Next in numerical importance were VENEREAL DISEASES, admissions for
which rose slightly in 1944 from 24 to 26 per 1,000. In 1945 an increase
of one-third was registered and admissions rose to 33. Rates for DIAR-
RHOEA decreased from 31 in 1943 to 25 in 1944 and 19 in 1945, and
DYSENTERY from 26 to 19 and 12 respectively. Admissions for SEPTIC
CONDITIONS also declined by fifty per cent. from 30 to 15.

Diseases of the EYE were responsible for rates which increased annually
from 16 in 1943 to 20 in 1945. A similar trend occurred with SCABIES
from 11 to 18, with Mumps from 8 to 12, TONSILLITIS from 5 to 8 and
with INFECTIVE HEPATITIS from 3 to 5 per 1,000.

Admissions for MENTAL, PSYCHONEUROTIC and PERSONALITY DIS-
ORDERS increased from 2-60 in 1943 to 4°00 in 1944 and declined to
2°51 in 1945. Rates for Diseases of the CIRCULATORY SYSTEM rose con-
siderably in 1944, from 0-14 to 7-18 and decreased in 1945 to 0-98.
DENGUE FEVER rates were comparatively low and varied little at 1-30,
1-76 and 0-81 respectively. Admissions for TUBERCULOSIS were relatively
low in 1943 at 0-28 but rose to 0-90 and 0-94 in the two ensuing years.

No admissions were recorded for SANDFLY FEVER or for the ENTERIC
Group of FEVERS in 1945 and there were none for SMALLPOX or for
Disorders of NUTRITION in 1943 and 1944.

ALL CEYLONESE TROOPS

In Table 147 are presented the admission rates to hospitals for All
Ceylonese Troops. As their composition was predominantly Other
Ranks, rates and trends tend to follow those of the Other Ranks (see
Table 146).

Rates of admissions for diseases experienced by these troops were
higher than those for any other class of troops. Admission rates of
British Troops were from eighty to ninety-three per cent. those of
Ceylonese and Indians from seventy-six to eighty-two per cent. A
comparative table is given below.

Ceylon
Comparative Table of Admissions
All Ceylonese, British and Indian Troops, 1943-45

1943 1944 1945
Ceylonese Troops. . ; ° 100 100 100
British Troops . y : 93 80 gt
Indian Troops . 3 ‘ s 82 80 76

Except for COMMON COLD, admissions for which were, on the average,
over 60 per 1,000 in excess of those of British or Indian Troops, no

THE ARMY MEDICAL SERVICES 413

individual diseases were responsible for excessive admissions among
Ceylonese Troops.

ALL TROOPS

Table 148 records the admission rates to hospitals of All Troops in
Ceylon. Rates for diseases only decreased annually from 702 to 418, a
decline of forty per cent. This compares with rates on the Indo-Burma
Front from 1,151 (in 1943) to 462, a decline of sixty per cent.

In each year, MALARIA caused the greatest number of admissions
among individual diseases. Rates increased in 1943 from 156 to 166.
This was due to the inclusion, in that year, of Ceylonese Troops whose
Other Ranks were responsible for the high admission rate of 215 per
1,000. In 1944 there was a decline by slightly over forty per cent. to 96,
and in the following year the rate was even lower at 70. A comparison
of these rates with those for All Troops on the Indo-Burma Front is
interesting.

Admissions for Malaria. All Troops
Comparison of Rates on the Indo-Burma Front with Ceylon, 1942-45

1945

Crude rates

Indo-Burma Front 63

Ceylon . Z 70
Comparative Rates (Indo-Burma Front

=I

Indo-Burma Front 100

Ceylon . 1
Comparative Rates (1942 = £00)

Indo-Burma Front 16

Ceylon . 45
Comparative Rates (Ereceain. pear, = #00)

Indo-Burma Front 19

Ceylon . 73

During the years 1942 to 1944 the Ceylon rate for Malaria was
between thirty and forty per cent. of that on the Indo-Burma Front,
but in 1945 it was ten per cent. higher. Taking the 1942 rates as a base,
the Ceylon rate in 1943 and 1944 was eighteen and twenty-one points
lower but in 1945 was twenty-nine points higher. When compared with
rates of the preceding year, in 1943 the Ceylon rate was 106 against
124, in 1944, 55 against 67 and in 1945, 73 compared with 19. It would
appear that the Anti-Malaria campaign was somewhat more successful

414 CASUALTIES AND MEDICAL STATISTICS

in Ceylon in 1944, but this was overshadowed by the overwhelming
reduction of admissions on the Indo-Burma Front in 1945.

The decline in admissions in respect of DENGUE FEVER was also im-
pressive. In 1942 there were 37 admissions per 1,000 troops; in 1943 and
1944 rates of 15 and 12 were recorded. In 1945 admissions had fallen
to under 4 per 1,000, at ten per cent. the rate for 1942. Admissions for
SEPTIC CONDITIONS also declined considerably from 53 to 16 per 1,000,
as did DIARRHOEA from 25 to 12, TONSILLITIS from 12 to 6, and Other
Diseases of the DIGESTIVE SYSTEM from 33 to 24. Rates for VENEREAL
DISEASES were 51 in 1942, 40 in 1943, 42 in 1944 and 30 in 1945.

Among British and Indian Troops, admissions for COMMON COLD
declined, in general, over the years. That this is not duplicated in Table
148 is due to the abnormally high rates experienced by Ceylonese
Other Ranks at over 80 per 1,000 during the last three years of the
period under review. This caused the All Troops rate of 28 in 1942 to
increase in 1943 and again in 1944 when it was 33, before declining to
27 in 1945.

Increases in admission rates were recorded by Other Diseases of the
RESPIRATORY SYSTEM from 13 to 21, SCABIES from 7 to 12, and MENTAL,
PSYCHONEUROTIC and PERSONALITY DISORDERS from 2-7 to 40 per 1,000.

INJURIES

Table 149 records the rates of admissions to hospitals on account of
injuries. As on the Indo-Burma Front, injuries have been classified
according to whether they were caused by enemy action (E.A.) or
otherwise (N.E.A.). The former have been sub-divided into Bomb,
Gunshot, and Shell wounds, but N.E.A. Injuries were not sub-divided
until 1945 and then only as to ‘Burns and Scalds’ and ‘Others’.

Admissions for Injuries ranged from 49 per 1,000 in 1942 to 32 in
1945, with 38 and 41 respectively in the two intervening years. In 1942
they accounted for six per cent. of the total admissions; in 1943 they
were less by one per cent., but in 1944 and 1945 they represented seven
per cent. of all admissions. This increase in relative rates is, of course,
due to the decline in admissions from disease.

N.E.A. Injuries

As Ceylon suffered comparatively little from enemy action, admis-
sions on account of N.E.A. Injuries were much higher than those for
E.A. Injuries, being from ninety-six to ninety-nine per cent. of all
injuries. The table below relating to N.E.A. Injuries, and condensed
from Table 149, compares the admission rates by the various categories
of troops.

As on the Indo-Burma Front, British Other Ranks suffered more
injuries than any other class of troops. Indeed, only once were they

THE ARMY MEDICAL SERVICES 415

Admissions to Hospital. N.E.A. Injuries
All categories of Male Troops, 1942-45. Crude and Comparative Rates

| Crude Rates Comparative Rates
(B. . = 100)

1942 | 1943 1944 | 1945 | 1942

British Other Ranks
British Officers

V.C.Os. and I.0.Rs.
N.Cs(E.) . 5

66 st 55 47 | 100
41 5° 38 100

65 47 52 43 98
25 | 27 58

43 $7 30
gt 8 =

Ceylonese Officers 7
Ceylonese Other Ranks.

E.A.O.Rs. .

= —= 34 —=

exceeded, in 1944, by Ceylonese Officers. B.O.Rs. produced rates which
varied between 66 per 1,000 in 1942 and 47 in 1945.This compares
with 33 to 64 on the Indo-Burma Front. N.E.A. Injury rates for V.C.Os.
and I.O.Rs. were over ninety per cent. of those for B.O.Rs., at from 66
to 43 per 1,000. Those for British Officers were also comparatively high
from 65 to 38 per 1,000. Admissions for N.Cs.(E.) were lowest with
rates which varied from 38 per 1,000 in 1942 to 14 in 1945. This low
rate of 14 per 1,000 was the lowest recorded for any class of troops in
Ceylon, India, or on the Indo-Burma Front.

E.A. Injuries

Rates of admission on account of Enemy Action Injuries were 1-80
in 1942, 0°44 in 1943, 0-31 in 1944 and 0-07 in 1945. The majority of
admissions in 1942 were among British Troops whose rate was 5:66.
Very few casualties occurred among Ceylonese Troops or East African
Other Ranks and among Non-Combatants (Enrolled) E.A., injuries
were recorded only in 1942.

DEATHS

Information regarding deaths in hospitals is even more meagre than
is similar data for the Indo-Burma Front. All that is known are the
rates per 1.000, by class of personnel, for each year (Table 150).

The highest mortality rates were recorded by E.A.O.Rs. at 3-56 in
1944 and 2:29 in 1945. N.Cs.(E.) provided the next highest rates which
varied from 2-13 to 3°22. This is surprising as they registered, on the
whole, admission rates which were lower than any other class. Rates
recorded by British Officers varied from 1-77 to 3-85 and those for
British Other Ranks were 1-66 to 2-72. There was but little difference
between the rates for V.C.Os. and I.0.Rs. and those for Ceylonese

416 CASUALTIES AND MEDICAL STATISTICS

Other Ranks at the range from 1-54 to 2-36 per 1,000. No deaths
occurred among Indian Officers or members of the I.M.N.S. during
the four years or among Ceylonese Officers in 1943.

MEDICAL ETHNOGRAPHY IN CEYLON

Due to the varying periods in which the various classes of troops
were stationed in Ceylon, it is not possible to present an ethnographical
comparison of admissions for all groups based on a period of longer than
two years. Some classes were on the Island for two and others for three
and four years and as, naturally, assumptions based on long periods
are more valid than others, the following discussion has been divided
into three parts:

(i) B.O.Rs. and V.C.Os. and I.O.Rs. for the four years, 1942 to 1945.
(ii) B.O.Rs., V.C.Os. and I.O.Rs., and Ceylonese Other Ranks for the
three years, 1943 to 1945, and

(iii) B.O.Rs., V.C.Os. and I.0.Rs., Ceylonese Other Ranks, and East

African Other Ranks for the two years 1944 and 1945.

B.O.RS., V.C.O8., AND I.0.RS.

Table 151 records the comparative rates of admissions to hospitals,
on account of diseases only, in respect of B.O.Rs., V.C.Os. and
I.0.Rs. The rates are based on average admissions of the four years,
1942 to 1945.

The total disease rate of I.O.Rs. was between eighty and ninety per
cent. of that for B.O.Rs. Of the twenty-five diseases and disease groups
listed in the table, nine recorded rates which, among Indians, were
higher than those for B.O.Rs. Experience elsewhere indicated that the
incidence of MUMPS among Indians was likely to be very much more
than among the British and that the rates of admission for SCABIES,
TUBERCULOSIS and DISEASES of the EYE would probably be twice as high.
These indications were fully realised. The Indian rate for MUMPS was
twelve times that for B.O.Rs., that for scares three times, and TUBER-
CuLosIs and Diseases of the EYE were twice as high. Also double the
B.O.R. rate was that for Diseases of the RESPIRATORY SYSTEM. Other
diseases which registered rates above those of B.O.Rs. were P.U.O. and
N.Y.D. Fever, Diseases due to Disorders of NUTRITION, Diseases of
the EAR, NOSE and THROAT, and sMALLPOx. Rates for these were between
twenty-five and fifty per cent. higher than those for B.O.Rs.

At the other end of the scale, the ENTERIC Group of FEVERS caused
admissions among B.O.Rs. at rates which were fourteen times those of
1.0.Rs., with DENGUE FEVER and TONSILLITIs at four times, and Other
Diseases of the sKIN at three times, the Indian rates. Admissions for
VENEREAL DISEASES and DIPHTHERIA among I.0.Rs. were approximately

THE ARMY MEDICAL SERVICES 417

three-fifths those of B.O.Rs. ; those for INFECTIVE HEPATITIS and MENTAL,
PSYCHONEUROTIC and PERSONALITY DISORDERS were slightly higher,
with DYSENTERY and Diseases of the CIRCULATORY SYSTEM at three-
quarters of the British rate.

There was but little difference in the rates for other diseases included
in the table.

Summary

Morbidity rates in Ceylon for B.O.Rs. as compared with V.C.Os. and
1.0.Rs. may be summarised as below.

Diseases with a com- Diseases with a com- Diseases with little
paratively high rate paratively low rate differences in rates
(in descending order) (in descending order)
Enteric Group of Fevers | P.U.O. and N.Y.D. Fever | Diarrhoea
Dengue Fever Diseases of the Sandfly Fever
Respiratory System
Tonsillitis Diseases of the Eye Other Diseases of the
Digestive System
Diseases of the Skin Tuberculosis Malaria
Venereal Diseases Scabies Septic Conditions
Diphtheria Mumps Common Cold

B.O.RS., CEYLONESE O.RS. AND V.C.OS. AND I.0.RS.

In Table 152 are the comparative rates of admission of British,
Ceylonese and Indian Other Ranks. As these rates are based on the
three years 1943 to 1945 the rates shown for Indian Other Ranks differ
somewhat from those given in Table 151, which were based on admis-
sions for four years. This is exemplified in the total admissions for
disease for which the comparative Indian rate for 1942-45 was 86 and,
for 1943-45 it was 89. Again the comparative Indian rate for Mumps
for 1942-45 was 1,243 whereas for the shorter period it increased to
1,936.

Although it produced admission rates of a relatively low order,
MUMPS, much more predominant among Ceylonese, was highest on the
list of comparative rates for both the non-European classes. COMMON
COLD was also prevalent among Ceylonese at between five and seven
times the British rates. Other Diseases of the RESPIRATORY SYSTEM, and
Diseases due to Disorders of NUTRITION were other diseases, the rates
for which were high among the Ceylonese, lower among Indians and
still lower for B.O.Rs.

There was little difference between the non-European rates for
SCABIES, or for Diseases of the EYE which were nearly three times and
double the British rate respectively. Admission rates for P.U.O. and
N.Y.D. Fever among the Ceylonese and Indians were one and a half

418 CASUALTIES AND MEDICAL STATISTICS

times those for B.O.Rs. while the Ceylonese rate for MALARIA was twenty-
five and the Indian ten per cent. higher than the British rate. The
SANDFLY FEVER rate among Indians was approximately one and a half
times that for the other two groups.

Admissions for DYSENTERY among non-Europeans were in the vicinity
of three-quarters of the British rate, but while the Indian rate for DIAR-
RHOEA was ten per cent. lower, that for Ceylonese was fourteen per
cent. higher.

TUBERCULOSIS provided the only example of a disease the rate for which
was high among one class of non-Europeans and low among the other.
Compared with B.O.Rs. the Indian rate was twice as high, whereas that
for the Ceylonese was one-third. The high Indian rate was partly due
to an unusually large number of admissions in 1942. Had the disease
followed the normal trend, the rates of British admissions to Indian
and Ceylonese may have been in the region of 3 : 2°5 : 1.

VENEREAL DISEASES and MENTAL, PSYCHONEUROTIC and PERSONALITY
DISORDERS produced comparative rates of approximately 70 among
Indians and 50 among Ceylonese, while there was little difference in
the rates for Diseases of the SKIN at 40, and TONSILLITIS at one-third the
British rate. Admissions of Non-Europeans for DIPHTHERIA were one-
twentieth of the rate for B.O.Rs. and the comparative rates for DENGUE
FEVER were 3 for Ceylonese as against 24 for Indians.

BRITISH , EAST AFRICAN, INDIAN AND CEYLONESE OTHER RANKS

Comparative rates of admissions to hospitals for disease in respect of
these classes of troops are contained in Table 153, and are based on the
average of known admissions for 1944 and 1945. The order of admis-
sions was Ceylonese at 117, British at 100, Indians at g1 and East
Africans at 34.

In only two diseases were the admission rates of each of the non-
European groups higher than those for B.O.Rs. These were Mumps
and Common Cold. The comparative rates for MUMPS were extremely
high at 7,200 for Ceylonese, 1,600 for Indians and 600 for East Africans.
For COMMON COLD, the Ceylonese again took pride of place at over eight
times, with Indians at approximately one and a half times and East
African slightly above, the British rate.

Other features of this table are:

(i) B.O.Rs. were more liable to be admitted for VENEREAL DISEASES,
the ENTERIC Group of FEVERS, INFECTIVE HEPATITIS, SEPTIC CON-
DITIONS, SMALLPOX and TUBERCULOSIS. They were also prone to
MENTAL, PSYCHONEUROTIC and PERSONALITY DISORDERS, TONSIL-
LiTIs, Diseases of the SKIN, DENGUE FEVER and DIPHTHERIA.

THE ARMY MEDICAL SERVICES 419

(ii) British and East African troops were more prone to DYSENTERY.

(iii) British and Ceylonese were more liable to contract DIARRHOEA
and Diseases of the CIRCULATORY SYSTEM.

(iv) Indians and Ceylonese were more susceptible to Diseases of the
EYE, Other Diseases of the RESPIRATORY SYSTEM, MALARIA, P.U.O.
and N.Y.D. rever, Diseases due to Disorders of NUTRITION, and
SCABIES.

(v) Ceylonese Other Ranks were more prone to Other Diseases of
the DIGESTIVE SYSTEM.

(vi) East Africans were less likely to contract Diseases of the EAR,
NOSE and THROAT.

These indications may be summarised as below:

DISEASE Prone Less Prone
Mumps Ceylonese, Indians, British
East Africans
Common Cold . . | Ceylonese, Indians British
Other Diseases of the
Respiratory System . | Ceylonese, Indians British, East Africans
Diseases of the Eye - | Ceylonese, Indians British, East Africans
Malaria : Ceylonese, Indians British, East Africans
P.U.O. and N.Y.D. Fever Ceylonese, Indians East Africans
Disorders of Nutrition . | Ceylonese, Indians East Africans
Dysentery . . | British, East Africans Ceylonese
Diseases of the Ear,
Nose and Throat . | Indians, British, Ceylonese| East Africans
Venereal Diseases . British Ceylonese
Enteric Group of Fevers British Indians, Ceylonese,
East Africans
Mental, Psychoneurotic
and Personality
Disorders . s . | British East Africans, Ceylonese
Infective Hepatitis. . | British East Africans
Smallpox. . . | British East Africans, Ceylonese
Tuberculosis S . | British East Africans, Ceylonese
Septic Conditions . . | British East Africans, Ceylonese
Tonsillitis . : . | British East Africans, Indians,
Ceylonese
Diseases of the Skin. | British East Africans, Indians,
Ceylonese
Diphtheria . F . | British East Africans, Indians,
Ceylonese
Dengue Fever : . | British East Africans, Ceylonese,
Indians
Diarrhoea. i . | Ceylonese, British East Africans, Indians
Diseases of the
Circulatory System . | Ceylonese, British East Africans
Other Diseases of the
Digestive System . | Ceylonese East Africans

Scabies i « | Ceylonese, Indians East Africans, British

420 CASUALTIES AND MEDICAL STATISTICS

TABLE 136

South-East Asia Command (Ceylon)

Causes o;

Admissions to Hospitals, 1942-45

British Officers. Annual Rates per 1,000 Strength

Source: A.F. A.31-B

COWIDA NUwWnn

~

CAUSES

Common Cold
Diarrhoea’.
Dysentery .
Dengue Fever
Diphtheria

Enteric Group of Fevers .
Infective Hepatitis Fs .
Malaria . ‘
Mumps e a h
Pneumonia. . .

P.U.O. and N.Y.D. Fever
Sandfly Fever.

Scabies . 7

Smallpox

Tonsillitis

Tuberculosis .

Venereal Diseases z

Diseases of the Circulatory
System _

Discases due to Disorders of
Nutrition .

Diseases of the Bar, “Nose and ”
Throat

Diseases of the Eye
Diseases of the Skin
(other than Scabies)
Other Diseases of the
Digestive System
Other Diseases of the
Respiratory System
Septic Conditions

Mental, Psychoneurotic and
Personality Disorders
All Other Diseases .

Total Admissions for Diseases .

Injuries—N.E.A.
Injuries—E.A.

Total Admissions for Injuries .

Total Admissions .

* Any cases included in ‘All Other Diseases’.

ODOMOID utewne

”

THE ARMY MEDICAL SERVICES 421

TABLE 137
South-East Asia Command (Ceylon)
Causes of Admissions to Hospitals, 1942-45
British Other Ranks. Annual Rates per 1,000 Strength

Source: A.F. A.31-B ers

CAUSES 1942 1943 1944 1945
I Common Cold. s 5 29°88 17°44 12°57 771 I
2 Diarrhoea. . 7 é 35°20 15°34 16°61 21°03 2
3 | Dysentery . : : : 27°81 | 25°23 | 29°37 | 20°34 3
4 | Dengue Fever " ‘ 5 78°83 | 54°11 53°08 19°81 4
5 Diphtheria . : = ‘ 1°58 0°68 3°93 orrs 5
6 Enteric Group of Fevers 5 2°46 O°31 0°77 0°30 6
7 | Infective Hepatitis : : 8-50 5°87 9°79 9°38 7
8 | Malaria ‘ : . 278-13 | 253°80 | 81-97 36-00 8
9 Mumps a Z a 0°32 _ o'10 or1s 9
10 | Pneumonia . 7 . . bs bs * — 10
Ir P.U.O. and N.Y.D. Fever 4 od +: 44°06 24°23 11
12 | Sandfly Fever 3 3 2-15 0°37 1°06 0°45 12
13 Scabies < 5 . Ai 4:85 4°45 3°84 6°96 13
14 | Smallpox. 2 5 5 _ _ or19 orrs 14
15 | Tonsillitis . ts 2 33°38 1§‘t5 12°67 16°49 1s
16 | Tuberculosis * as 1°35 1°55 3°36 I's. 16
17. | Venereal Diseases . e 112°68 | 62°52 46°84 61°56 17
18 | Diseases of the Circulatory
System a 0°08 0-18 3°17 3°93 18
19 Discases due to Disorders of
Nutrition . i _ _— _ 0°76 19
20 Diseases of the Ear, Nose and
at s : * * 20°73 19°81 20
21 Diseases of the Eye : 11°44 7°30 6-43 9°68 21
22 | Diseases of the Skin (other
than Scabies) . if . = * 47°99 68-82 22
23 | Other Diseases of the
Digestive System Q % 42°04 33°02 31-16 23
24 | Other Diseases of the
Respiratory System. : 8-18 16-03 13°76 24
25 | Septic Conditions . ¢ 2 88-37 29°28 31°62 | 25
26 | Mental, Psychoneurotic and
Personality Disorders . : 5°48 4°89 10-29 | 26
27 | All Other Diseases : ‘ 21°22 120°48 | 159°28 | 27
28 Total Admissions for Diseases | 1,093°93 602°23 | 584°33 28
29 Injuries—N.E.A. . Z i 66-43 54°62 | 46°89 | 29
jo Injuries—E.A. 3 . ° 5°32 0:67 Ors 30
31 Total Admissions for Injuries 71°75 55°29 | 47°04 | 31
32 Total Admissions a - |1,165°69 657°52 | 631°37 32

* Any cases included in ‘All Other Diseases’.

422 CASUALTIES AND MEDICAL STATISTICS

TABLE 138
South-East Asia Command (Ceylon)

Causes of Admissions to Hospitals, 1942-45
All British Troops. Annual Rates per 1,000 Strength

Source: A.F. A.31-B

CAUSES
1 Common Cold = 29°49 16°99
2 | Diarrhoea . : 34°93 1601
3 Dysentery . a ry 28°24 25°81
4 | Dengue Fever . s < 82°28 | 55°56
5 | Diphtheria : Y a 1°98 0°59
6 | Enteric Group of Fevers 2°28 0°32
7 | Infective Hepatitis. eS 9°63 5°79
8 Malaria 5 ‘, A 267-22 | 238-22
9 Mumps sf . * 0°37 orl
10 | Pneumonia . ‘i : *
11 | P.U.O. and N.Y.D. Fever M3 Ad
12 | Sandfly Fever : s 1°98 0°32
13 | Scabies ee ‘ ‘ 4°49 4°06
14 | Smallpox. a - _
15 Tonsillitis . 5 32°72 15°09
16 | Tuberculosis é FS FS 1°40 I°Sr
17 | Venereal Diseases . . 104°93 55°56
18 | Diseases of the Circulatory
System. : 0°07 0°22
19 Diseases due to Disorders of
Nutrition — _
20 | Diseases of the Ear, Nose and.
Throat’. : . *
art | Diseases of the Eye 5 $ Ine17 6-60
22 | Diseases of the Skin (other
than Scabies) * *
23 Other Diseases of the
Digestive System . 34 40°20
24 | Other Diseases of the
Respiratory System. r 8-31 3°52
25 | Septic Conditions . : ‘ 88-61 31°43
26 | Mental, Psychoneurotic and
Personality Disorders . . 5°51 3°79
27 | All Other Diseases ‘ . 319°47 | 272°00
28 Total Admissions for Diseases | 1,079°42 | 793°70
29 | Injuries—N.E.A. . . 66-40 49°94
go Injuries—E.A. S : . 5°66 0°59
31 Total Admissions for Injuries 72°06 | 50°53
32 Total Admissions 5 » {1,t5

* Any cases included in ‘All Other

Diseases’.

COOMA UbWwnn

THE ARMY MEDICAL SERVICES

TABLE 139

South-East Asia Command (Ceylon)
Causes of Admissions to Hospitals, 1942-44
Indian ers. Annual Rates per 1,000 Strength

Source:A.F. A.31-B

COMI A UbWdH

mI

CAUSE

Common Cold .
Diarrhoea.
Dysentery
Dengue Fever .
Diphtheria <

Enteric Group of Fevers
Infective Hepanies
Malaria

Mumps .

Pneumonia

P.U.O. and N.Y.D. Fever
Sandfly Fever %
Scabies

Small;

Tonsillitis

Tuberculosis .

Venereal Diseases é

Diseases of the Circulatory
System

Diseases due to Disorders of
Nutrition

Diseases of the Bar, Nose and
Throat

Diseases of the Eye. .

Diseases of the Skin (other than
Scabies) .

Other Diseases of the Digestive
System.

Other Diseases of the Respiratory
System .

Sepuic Conditions &

Mental, Psychoneurotic and
Personality Disorders

All Other Diseases. f
Total Admissions for Diseases

Injuries—N.E.A.
Injuries—E.A.

Total Admissions for Injuries
Total Admissions . .

* Any cases included in ‘All Other Diseases’.
Note: No data are available for 1945

423

COOMA Ubwna

424 CASUALTIES AND MEDICAL STATISTICS

Source: A.F. A.31-B

OO OID UAWNH

~

TABLE 140

South-East Asia Command (Ceylon)
Causes of Admissions to Hospitals, 1942-45
Annual Rates per 1,000 Strength

V.C.Os. and 1.0.Rs.

CAUSES

Common Cold
Diarrhoea.

Dengue ever
Diphtheria.

Enteric Group of Fevers .
Infective Hepatitis .
Malaria . .
Mumps .

Pneumonia

P.U.O. and N.Y.D. Fever
Sandfly Fever

Scabies .

Smallpox

Tonsillitis

Tuberculosis .
Venereal Diseases .
Diseases of the Circulatory

System
Diseases due to Disorders of
Nutrition

Diseases of the Ear, ‘Nowe ‘and?
Throat e

Diseases of the Eye
Diseases of the Skin (other
than Scabies) . :.
Other Diseases of the
Digestive System
Other Discates Of the
espiratory System =.
Septic Conditions . <

Mental, Psychoneurotic and
Personality Disorders
All Other Diseases .

Total Admissions for Diseases .

Injuries—N.E.A.
Injuries—E.A.

Total Admissions for Injuries .

Total Admissions

* Any cases included in ‘All Other Cases’.

OCOWOIA Nawne

~

THE ARMY MEDICAL SERVICES 425

TABLE 141

South-East Asia Command (Ceylon)
Causes of Admissions to Hospitals, 1942-45
Non-Combatants (Enrolled). Annual Rates per 1,000 Strength

Source: A.F, A.31-B

CAUSES 1942 1943 1944 | 1945
1 Common Cold - 4 3 12°78 17°60 10°90 2°56 1
2 Diarrhoea of 3 m q 21°00 10°64 8-46 4°09 2
3 | Dysent : : : «| 10°35 | 12°77] 18°54 9°75 3
4 | Dengue Fever » ee | 29s | 12°77] 5°74] 20] 4
5 Diphtheria. é 3 : 0°30 org 0-08 _ 5
6 Enteric Group of Fevers 7 _ o'19 0-16 0-20 6
7 Infective Hepatitis . 4 es 2°13 2°32 4°29 1°90 7
8 Malaria - 2 . . | 210°29 | 156-32 | 97°36 | 61-22 8
9 Mumps ‘ 5 F s 0°91 0°97 0°99 2°03 9
10 Pneumonia. 2 x - - bf ; 0°63 10
Wr P.U.O. and N.Y.D. Fever s bd 36:99 | ar-so| 11
12 Sandfly Fever. F s ‘ oor 0°39 0-25 _ 12
13 Scabies . : ‘5 ij ‘. 7:00 9°87 5°82 7°59 13
14 Smallpox - 5 2 7 0°30 _ 0°04 0°07 4
1s Tonsillitis is 2°43 3°48 3°43 1°16 15
16 Tuberculosis . ‘ 3 ‘ 2°74 6-96 1°16 0°60} 16
17 Venereal Diseases . bs 3 72°43 56°10 | 21°39 9°48 17
18 Diseases of the Circulatory
System . : _- 0°97 1°94 o17| 18
19 Diseases due to Disorders of
Nutrition . z 3 a _ _ o'74 o'10 19
20 Diseases of the Ear, Nose and
Throat 2 ; Q é : * 9°50 | 10°35 | 20
21 Diseases of the Eye : ‘ 17°04 10°64 4°95 4°56] 21
22 Diseases of the Skin (other
than Scabies) e 2 Ls = 8-67 5°62 | 22
23 Other Diseases of the
Digestive System > 2 31°95 50°69 | 17°34 8-85] 23
24 Other Diseases of the
Respiratory System. : 8-52 6°38 | 22°46 11-21 24
25 Septic Conditions - a Z 33°47 27°66 | 20°07 1n-a1 25

26 Mental, Psychoneurotic and

Personality Disorders . = 1°52 4°06 3°18 2°23 26
a7 All Other Diseases . G « | 3x6°52 | 276-08 56°41 30°31 27
28 Total Admissions for Diseases . | 777°54 | 667-05 | 360°86 | 208-59 | 28
29 Injuries—N.E.A. . . é 38°34 24°76 | 26°80 13°84 | 29
30 Injuries—E.A. 5 4 a 0°30 _ _ _ 30
at Total Admissions for Injuries . 38°64 | 24°76 | 26-80 3t
32 Total Admissions : « | 816-19 | 691-82 | 387°65 | 222-43 | 32

* Any cases included in ‘All Other Diseases’.

426 CASUALTIES AND MEDICAL STATISTICS

TABLE 142

South-East Asia Command (Ceylon)
Causes of Admissions to Hospitals, 1942-45
Indian Military Nursing Services. Annual Rates per 1,000 Strength

Source: A.F. Ag 1-B

‘CAUSES

1 Common Cold 1
2 Diarrhoea 2
3 | Dysentery . 3
4 Dengue Fever 4
5 Diphtheria 5
6 | Enteric Group of Fevers . 6
7 Infective Hepatitis. 7
8 Malaria . . . 8
9 Mumps. 9
10 | Pneumonia 10
ur P.U.O. and N.Y.D. Eee %: oa
12 Sandfly Fever. 3 5 12
13 Scabies . . : : 4 3
14 Smallpox 2 3 a 5 14
1§ Tonsillitis B . < * 15
16 Tuberculosis . . , . 16
17 | Venereal Diseases . . 7
18 Diseases of the Circulatory
System is 18
19 Diseases due to Disorders of
Nutrition . rn 19
20 Diseases of the Ear, Nose and
at F t ‘ 5 . 20
ar Diseases of the Eye - ; 5 au
22 | Diseases of the Skin
(excluding Scabies) : * 22
23 Other Diseases of the
Digestive System ss re * . . 23
24 Other Diseases of the
4 Respiratory System < a . 24
25 Septic Conditions . ; 5 : . ba 25
26 Mental, Psychoneurotic and
Personality Disorders . ¢ 26
27 All Other Diseases . % % . . . . 27
28 Total Admissions for Diseases . . . . : 28
29 Injuries—N.E.A. . 5 ; . 29
30 Injuries—E.A. : a 2 30
31 Total Admissions for Injuries . i 31
32 Total Admissions : : . . . . 32

* Any cases included in ‘All Other Diseases’.

THE ARMY MEDICAL SERVICES 427

TABLE 143

South-East Asia Command (Ceylon)
Causes of Admissions to Hospitals, 1942-45
All Indian Troops. Annual Rates per 1,000 Strength

Source: A.F. A.31-B ——

CAUSES
1 Common Cold 1
2 Diarrhoea. a . . 2
3 Dysentery . 5 2 . 3
4 Dengue Fever ; . 4
5 Diphtheria. ‘s 5
6 Enteric Group of Fevers . 6
7 Infective Hepatitis . 7
8 jaria . 8
9 | Mumps .— 9
1o | Pneumonia 10
tr | P.U.O. and N.Y.D. Fever 11
12 Sandfly Fever 12
13 Scabies . a x . * 13
14 Smallpox eC * , i. 14
15 Tonsillitis ? ‘ 15
16 | Tuberculosis . 16
17 | Venereal Diseases . 17
18 Diseases of the Circulatory 18
System
19 Diseases due to Disorders of
Nutrition . 19
20 Diseases of the Ear, Nose ‘and
at 20
21 Diseases of the Eye ¢ ar
22 Diseases of the Skin (other
than Scabies) a 3 22
23 Othe Diseases of the
gestive System 23
24 | Other Diseases of the
Respiratory System 24
25 Septic Conditions 25
26 Mental, Psychoneurotic and
Personality Disorders 26
27 All Other Diseases . 27
28 Total Admissions for Diseases . 28
29 Injuries—N.E.A. a 29
30 Injuries—E.A. 4 + 30
31 Total Admissions for Injuries . 65°51 : p : 31
32 Total Admissions y « | 928-70 2 e : 32

* Any cases included in ‘All Other Diseases’.

428 CASUALTIES AND MEDICAL STATISTICS

TABLE 144

South East Asia Command (Ceylon)

Causes of Admissions to Hospitals, 1944-45
East African Other Ranks. Annual Rates per 1,000 Strength

Source: AF. A.31-B

COOMA Ubwnn

CAUSES:
Common Cold . .
Diarrhoea . : ‘
Dysent "s a Z
Dengue Fever . é .
Diphtheria ‘ 5

Enteric Group of Fevers
Infective Hepatite 4 5
Malaria . : .
Mumps .

Pneumonia

P.U.O. and N.Y.D. Fever .
Sandfly Fever .

Scabies. . : ; x
Smallpox .
Tonsillitis
Tuberculosis. : . .

Venereal Diseases

Diseases of the Circulatory System
Diseases due to Disorders of Nutrition |
Diseases of the Ear, Nose and Throat

Diseases of the Eye .
Diseases of the Skin (other than Scabies)
Other Diseases of the Digestive System

Other Diseases of the Respirmtory: System

Septic Conditions

Mental, Psychoneurotic and Perwonalltys Disorders .

Other Diseases
Total Admissions for Diseases.
roar
Total Admissions for Injuries
Total Admissions .

ODOUR UeWwnn

™

* Any cases included in ‘All Other Diseases’.

THE ARMY MEDICAL SERVICES 429

TABLE 145

South-East Asia Command (Ceylon)
Causes of Admissions to Hospitals, 1943-45
Ceylonese Officers. Annual Rates per 1,000 Strength

Source: A.F. A.31-B

CAUSES 1944 1945

1 Common Cold . 21°96 14°13 1
2 Diarrhoea 10°13 12°96 2
3 | Dysentery 6-76 4°71 3
4 Dengue Fever. 5°07 3°14 4
5 Diphtheria . - _ _ 5
6 Enteric Group of Fevers _ 6
7 Infective Hepatitis 8-45 4°71 7
8 | Malaria 57°43 | 45°53 8
9 | Mumps. 4 1-69 1°57 9
10 | Pneumonia . : _ _ 10

1x | P.U.O. and N.Y.D. Eever f
12 Sandfly Fever. :
13 Scabies : ‘
14 Smallpox . 2 z
15 Tonsillitis . e y

16 Tuberculosis p ‘ S

7 Venereal Diseases 6:26 7
18 | Diseases of the Circulatory System 3°38 1°57 18
19 Diseases due to Disorders of Nutrition —_ 4°71 19

20 | Diseases of the Ear, Nose and Throat

ar Diseases of the Eye.
az Diseases of the Skin (other than Scabies)
23 Other Diseases of the Digestive System .
24 | Other Diseases of the Respiratory System
25 Septic Conditions S

26 =| Mental, Pavehionetirotic, and Personality

Disorders Ai 1°69 _ 26
27 | All Other Diseases ji é 123°93 86°34 | 27
28 Total Admissions for Diseases 386-82 | 306-12 28

29 | Injuries—N.E.A. . a 57°43 | 29°83 | 29

30 Injuries—E.A. . 1°87 30
31 Total Admissions for Injuries ; 57°43 31°40 | 31
32 Total Admissions 444°26 | 337°52 | 32

* Any cases included in ‘All Other Diseases’.

430 CASUALTIES AND MEDICAL STATISTICS

TABLE 146

South-East Asia Command (Ceylon)
Causes of Admissions to Hospitals, 1943-45
Ceylonese Other Ranks. Annual Rates per 1,000 Strength

Source: A.F. A.31-B

I Common Cold . 3 3 é : 80-94 I
2 Diarrhoea . ; : ‘ % 5 18-87 z
3 Dysentery . i a i s 11°59 3
4 Dengue Fever . 5 me a 0-81 4
5 Diphtheria . a u Z or13 5
6 | Enteric Group of Fevers 6
7 | Infective Hepatits 5°11 v4
8 Malaria ‘ 109°O1 8
9 Mumps & a z 12°40 9
10 Pneumonia . 3, 5 rs 3°07 10
rn P.U.O. and N.Y.D. Fever 32°80 rn
12 Sandfly Fever. ‘ _ 12
13 Scabies > if a 18-40 13
14 | Smallpox . : : or13 14
15 Tonsillitis . - 771 15
16 Tuberculosis : Z Fe S | 0°94 16
7 Venereal Diseases Fs a! 33°48 17
18 Diseases of the Circulatory System™ . 0-98 18
19 Diseases due to Disorders of Nutrition 1°66 19
20 Diseases of the Ear, Nose and Throat 19°72 20
ar Diseases of the Eye 19°72 an
a2 | Diseases of the Skin (other than Scabies) 23°34 | 22
23 Other Diseases of the Digestive System . 38-68 23
24 Other Diseases of the Respiratory System 35°39 | 24
25 Septic Conditions 3 14°61 25
26 Mental, Psychoneurotic and Bersonality
Disorders S - 5 2°51 26
27 All Other Diseases < 7 s 125°81 27
28 Total Admissions for Diseases. 617°81 28
29 Injuries—N.E.A. % é 42°55 29
30 Injuries—E.A. . és 3 _ go
31 Total Admissions for Injuries s 42°55 31
Total Admissions 5 b > ‘ 32

* Any cases included in ‘All Other Diseases’.

THE ARMY MEDICAL SERVICES 431

TABLE 147

South-East Asia Command (Ceylon)
Causes of Admissions to Hospitals, 1943-45
All Ceylonese Troops. Annual Rates per 1,000 Strength

Source: A.F. A.31-B

I Common Cold . . 7 f F 80-03 | 87°83 ) 79°17 1
2 Diarrhoea . a a Pi . 30°09 25°03 18°70 2
3 | Dysentery . : : : . + | 25°53 | 18:57 | 11°40 3
4 Dengue Fever . . ‘ : 5; 1°35 1°84 0°87 4
5 Diphtheria . é : ‘ _ . 009 0°04 o-12 5
6 Enteric Group of Fevers o°13 0°29 _ 6
7 Infective Hepetitis 4 5 3°16 5°07 5°10 7
8 Malaria 3 2 u 5 « | 210°76 | 141-92 | 107°33 8
9 | Mumps. = ‘ 3 é ‘ 7:40 5°53 | i247 9
to | Pneumonia . - 2 : 5 ig * 2°99 10
1 P.U.O. and N.Y.D. Fever . < * 69°68 | 32°31 W
12 Sandfly Fever. A f o°41 1°30 _ 12
13 Scabies . cS : . % < 10°29 13°12 18+12 13
14 Smallpox . z f 2 5S % _- _ or12 14
15 Tonsillitis . 7 hs fi 5 x 4°74 3°65 7°63 15
16 | Tuberculosis 5 5 : é 0:27 0°96 0°95 16
17 Venereal Diseases 4 23°91 25°78 32°76 7
18 Diseases of the Circulatory System : or13 7°08 0°99 18
19 Diseases due to Disorders of Nutrition - _ _ 1°94 19
20 Diseases of the Ear, Nose and Throat . * 17°48 16-66 20
21 Diseases of the Eye. 15°20 17°48 16°83 21
22 | Diseases of the Skin (other than Scabies) hg 26°58 | 23°27 | 22
23 Other Diseases of the Digestive System . 39°97 42°39 38°24 23
24 Other Diseases of the Respuatory System 28°55 41°84 34°97 24
25 Septic Conditions < 29°23 14°92 14°35 | 25
26 Mental, Psychoneurotic and
Personality Disorders < . f 2°53 3°94 2°45 26
27 All Other Diseases r é e . | 337°72 | 189-29 | 130°39 27
28 Total Admissions for Diseases. « | 851-49 | 761-61 | 609°57 28
29 Injuries—N.E.A. S ¢: 5 = 4g 47°96 42°22 29
30 Injuries—E.A. . é 2 é bi 0°04 or13 0°04 30
31 Total Admissions for Injuries 5 6 41°18 48-09 42°26 31
32 Total Admissions 7 c - . | 892-68 | 809-70 | 651-83 | 32

* Any cases included in ‘All Other Diseases’.

432 CASUALTIES AND MEDICAL STATISTICS

Source: A.F. A.31-B

TABLE 148

South-East Asia Command (Ceylon). Causes of Admissions to Hospitals, 1942-45
All Troops. Annual Rates per 1,000 Strength

CAUSES

COMIA Uewnn

31
32

Common Cold
Diarrhoea. f
Dysentery

Dengue Fever
Diphtheria

Enteric Group of Fevers .
Infective Hepatitis is
Malaria . .
Mumps.

Pneumonis

P.U.O. and N.Y.D. Fever
Sandfly Fever.

Scabies

Small, :
Tonsillitis . .

Tuberculosis .

Venereal Diseases .

Diseases of the Circulatory
System

Diseases due to Disorders of
Nutrition

Diseases of the Ear, "Nose ‘and 5

at

Diseases of the Eye

Diseases of the Skin (other
than Scabies) 4 ‘

Other Diseases of the
Digestive System

Other Diseases of the
Respiratory System

Septic Conditions

Mental, Psychoneurotic and
Personality Disorders
All Other Diseases .

Total Admissions for Diseases .

Injuries—N.E.A.
Injuries—E.A.

Total Admissions for Injuries .

Total Admissions

12°56
.

33°48

13°10

53°19

2°72
243°78

702°45

46°93
1°80

48°73

32°23

751°18

579°14 | 450°71

OO ONIAD NAWD mH

”

® Any cases included in ‘All Other Diseases’.

433

THE ARMY MEDICAL SERVICES

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434 CASUALTIES AND MEDICAL STATISTICS

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THE ARMY MEDICAL SERVICES 435
TABLE 150
South-East Asia Command (Ceylon)
Deaths in Hospitals,1942-45. All Causes
Annual Rates per 1,000 Strength
1942 1943 1944 1945

British

Officers . “ es 2:07 1°77 3°85 1°92

Other Ranks . 5 2°22 2°72 1°82 1°66
Indian

Officers . : = = _ =

V.C.Os. and I.0.Rs._ . 1°86 2°35 1°95 1°54

N.Cs.(E.) z * zi 2°13 2°90 3°22 2°16

1.M.N.S. . . _ _ = =
Ceylonese

Officers . a 2 z _ 1°69 1°57

Other Ranks ‘ 2°36 1°55 1°96
East African

Other Ranks

TABLE 151
South-East Asia Command (Ceylon). Admissions to Hospitals for Diseases, 1942-45
Comparative Rates B.O.Rs. and V.C.Os. and I.0.Rs.

Source: A.F.A.31-B ——— ees

DISEASES B.O.Rs.
1 Mumps 100
2 Scabies "i FE * : . . 100
3 Tuberculosis a < ‘ 100
4 Diseases of the Eye H 3 100
5 Other Diseases of the Respiratory System . g 100
6 P.U.O. and N.Y.D. Fever* _.. : é 100
7 | Diseases due to Disorders of Nutrition | e 100
8 | Diseases of the Ear, Nose and Throat* . 7 100
9 Smallpox # = . + 100
10 Diarrhoea. : . . . 7 : 100
1x Sandfly Fever Ms I 100
12 Other Diseases of the Digestive System ‘ ‘ 100
13 Malaria : - = 7 . 100
14 Septic Conditions . é . 5 5 ‘ 100
15 Common Cold . 5 @ * é j 100
16 Dysentery . < a 100
7 Diseases of the Circulatory System Z G 100
18 Infective Hepatitis . . 2 : * a 100
19 Mental, Psychoneurotic and
Personality Disorders . é . é ‘ 100
20 | Diphtheria . : 5 S < 2 ‘ 100
21 Venereal Diseases . . 100
22 Diseases of the Skin (other than Scabies)* 100
23 Tonsillitis. A! A " 7 100
24 Dengue Fever : ‘ S : 4 100
25 Enteric Group of Fevers" y 2 . ° 100
26 | All Other Diseases 2 5 5 z ; 100
27 Total Admissions for Diseases. ‘ < 100

* Based on admissions for two years only.

15CMS

V.C.Os
and

1.0.Rs.

1,243 I
291 2
arr 3
202 4
191 5
148 6
137 7
131 8
125 9

98 10
98 bea
95 12
93 13
90 14
90 15
76 16
76 17
65 18
65 19
63 20
59 21
36 22
25 23
23 24

7 25
92 26

436 CASUALTIES AND MEDICAL STATISTICS

TABLE 152

South-East Asia Command (Ceylon). Admissions to He

Comparative Rates British, Ceylonese and Tnd

Source: A.F. A.31-B

27

ttals for Diseases, 1943-45

ian Other Ranks

DISBASES British | Ceylonese| Indian

Mumps. S 100 10,256 1,936 1
Common Cold 100 11g 2
Other Diseases of the ie Respiratory

System 100 322 188 3
Scabies . 100 278 279 4
Diseases of the Eye" 100 222 203 5
Diseases due to Disorders of

Nutrition . 100 a8 138 6
P.U.O. and N.Y.D. "Fever* 100 151 148 7
Malaria . 100 126 110 8
Other Diseases of the 1 Digestive

System 100 117 85 9
Diarrhoea 100 114 go 10
Diséases of the Circulatory System 100 114 75 W
Sandfly Fever. 100 93 144 12
Diseases of the Ear, Nose and Throat* 100 92 131 13
Dysentery ‘i 100 67 79 14
Septic Conditions 100 64 98 15
Infective Hepatitis . 5 a 100 53 60 16
Venereal Diseases . 5 100 49 vhs 7
Mental, Psychoneurotic and

Personality Disorders . 100 48 Jo 18
Diseases of the Sia. (other than

Scabies)* 100 43 36 19
Smallpox 100 38 97 20
Tonsillitis 100 36 31 ar
Tuberculosis . ss 100 33 200 22
Enteric Group of Fevers | 100 32 10 23
Diphtheria 100 5 7 24
Dengue "Fever : 100 3 24 25
All other Diseases . 100 120 84 26

Total Admissions for Diseases 100 113 89 27

* Based on admissions for two years only.

THE ARMY MEDICAL SERVICES 437

TABLE 153

South-East Asia Command (Ceylon). Admissions to Hospitals f or Dee 1944-45
an,

Comparative Rates 0;
Ceyl
Source: A.F. A.31-B

DISEASES:

British, East
2 Other R

|

1 Mumps

2 | Common Cold

3 Sandfly Fever.

4 | Dysentery . :

5 Other Diseases of the
Respiratory System

6 | Venereal Diseases .

7 Diseases of the Eye

8 Diarrhoea.

9 Diseases of the Circulatory

System *
10 Enteric Group of Fevers .

Wr Diseases of the Ear, Nose and

t . . .
12 Mental, Psychoneurotic and
Personality Disorders
13 Infective Hepatitis .

1s P.U.O. and N.Y.D. Fever

16 tic Conditions

7 Diseases of the
Digestive System 5

18 Diseases due to Disorders of
Nutrition :

19 Scabies . . 4,

20 Tonsillitis

21 Diseases of the Skin (other
than Scabies) i

22 D ¢ Fever

23 Smallpox :

24 Tuberculosis .

25 Diphtheria

26 All Other Diseases .

27 Total Admissions for Diseases .

* Admissions for one year only.

oo CIA NH WN

CHAPTER X
Discharges from the Army on Medical Grounds

HE statistics which follow were prepared from Hollerith tabulations,

the basic data for which were contained on Army Forms B.3978.

Presidents of Medical Boards were required, as from September 1,
1942, to complete these forms for all cases approved for invaliding from
the Army, that is, those placed in Medical Category E.

As discharges on medical grounds could be effected only in the
United Kingdom, medical boards convened overseas could only
recommend for transfer home as invalids those cases they considered
should be invalided out of the Army. On arrival in the United Kingdom,
the patients continued to receive medical treatment in hospitals, appeared
before medical boards and were either:

(a) placed in Medical Category E,
(b) medically up- or down-graded and returned to duty, or,

(c) graded temporarily unfit as requiring further hospital in-patient
treatment.

Patients admitted to medical units in the United Kingdom considered
by their medical officers as suitable for invaliding received similar
administrative treatment.

Presidents of medical boards were empowered only to recommend
discharge from the Army; approval was vested in the local medical
administrative officers, while discharges were carried out by the medical
units in which the patients were being treated.

Data from all Army Forms B.3978 received in the War Office were
transferred to Hollerith punched cards. In view of the known limitations
of war-time medical statistics produced by the Hollerith machines, and
in common with other Hollerith tabulations, overall figures have been
checked against another source of information. The result showed a
high degree of similarity, albeit there was evidence of a slight leakage
of the forms in transit.

Comparison is also possible with statistics on this subject published
in the Statistical Report on the Health of the Army, 1943-45. The
differences existing between the two sets of figures are reasonably small,
so that it may be said that the tabulations which follow are substantially
correct. Data are grouped astomales(Officersand Other Ranks combined)
and females (A.T.S. Officers and Other Ranks combined). No rates can
be quoted for the discharge of nurses and V.A.D. members due to the
lack of accurate strength figures.

438

THE ARMY MEDICAL SERVICES 439

MALES

Discharge rates of males are cited in Tables 154 to 158. It must be
emphasised that these rates are for the whole army and not that part
stationed in the United Kingdom only.

A summary of discharge rates is given in Table 154. Invalidings on
account of diseases only increased by 3 per 1,000 each year, from 18 in
1943 to 24 in 1945. Injuries produced rates of 3, 5 and 9 per 1,000
respectively and accounted for some fourteen, twenty and twenty-seven
per cent. of discharges for all medical reasons. Total discharges rose in
1944 by 5 per 1,000 to 26 and to 33 in the following year.

By far the largest number of discharges in each year was on account
of MENTAL DISORDERS (Table 155). In 1943, thirty-five per cent. of all
discharges through disease were attributable to this cause. During the
following year, the proportion rose to forty-one per cent. and in 1945 it
declined very slightly to forty per cent. Expressed as rates per 1,000
strength, discharges rose from 6 in 1943 to 8-6 in 1944 and finally to 9-4
in 1945. Discharges due to this group are analysed below.

Discharges from the Army on Medical Grounds, 1943-45
ental Disorders. Relative Rates
Source: Hollerith Tabulations

1945
Psychoses:

Manic Depressive . 2°89
Schizophrenia 5°69
Paranoid State 0°47
ers. 0°07

Psychoneuroses.
Anxiety State 53°30
Hysteria 16°34
Others if 1°56
Psychopathic Personality 13°79
Mental Deficiency 5°72
Other Mental Disorders or17
100

ANXIETY STATE contributed to between forty and fifty per cent. of
discharges due to mental disorders, and HYSTERIA to between sixteen and
twenty per cent. PSYCHOPATHIC PERSONALITY accounted for approxi-
mately fifteen per cent. and SCHIZOPHRENIA and MENTAL DEFICIENCY for
six per cent. each. There was a marked decline over the three years in
discharges due to MANIC DEPRESSIVE Psychosis, the number in 1945 being
slightly over one-half those in 1943 (the mean strength in 1945 was
some five per cent. less than that in 1943). This was reflected in a
decline in the relative rates from six to less than three per cent.

440 CASUALTIES AND MEDICAL STATISTICS

Next in numerical importance came Diseases of the DIGESTIVE
SYSTEM, discharges for which, producing rates at around 3 per 1,000
strength were almost one-third those for mental disorders. An analysis of
these discharges follows.

Discharges from the Army on Medical Grounds, 1943-45
Diseases of the Digestive System. Relative Rates

Source: Hollerith Tabulations

1943 1944 1945
Gastric Ulcer. E : 3 e 12°64 12°75 12°72
Duodenal Ulcer ., e < ry 62°64 60°83 57°42
Peptic Ulcer—unspecified . ‘ . 2°40 3°63 3°84
Perforated Ulcer 7 7 3 ‘ 3°68 4°59 5°77
Dyspepsia and Cenite Fi . : 6°73 5°69 4°87
Hernia. * 5 a 2°73 2°47 2°85
Appendicitis . ‘ + : . 0°23 0°23 0°50
Haemorrhoids . or19 O14 0-10
Other Diseases of the. Digestive System 8-76 9°67 1I'93

Four-fifths of these discharges were due to Ulcers, sixty per cent. to
DUODENAL Ulcers, twelve per cent. to GASTRIC and eight per cent. to
PERFORATED and UNSPECIFIED Ulcers. Six per cent. were due to
DYSPEPSIA and GASTRITIS and nearly three per cent. to HERNIAS. It is
worthy of notice that in a group of diseases which caused such a large
number of discharges, relative rates of individual diseases within the
group varied but little. Indeed, in the largest component of the group,
the variation is only five per cent.; among the next largest component,
the variation is as low as 0-11 per cent.

Discharges due to Diseases of the RESPIRATORY SYSTEM were between
seven and eight per cent. of all those due to disease, at rates which varied
little from 1-4 per 1,000 in 1943 to 1-6 in 1945. The following analysis
show that from fifty to sixty per cent. of these discharges were due to
BRONCHITIS, at least three quarters of which were chronic. ASTHMA
provided between fifteen and twenty per cent. of the total and PLEURISY
an average of three per cent. over the period.

Discharges from the Army on Medical Grounds, 1943-45
Diseases of the Respiratory System. Males. Relative Rates

Source: Hollerith Tabulations

1943 1944 1945
Bronchitis 7 . ‘ % - 61°63 60°32 50°29
Asthma . a ‘i 5 . 15°27 14°56 21°52
Pleurisy . 2°37 2°55 4°39
Other Diseases of the Respiratory System 20°72 22°87 23°80

100 100 100

THE ARMY MEDICAL SERVICES 441

Diseases of the MUSCULO-SKELETAL SYSTEM were responsible for
discharges at rates within the range 1-4 to 1-6 per 1,000 strength and
representing approximately seven per cent. of all discharges for disease.
They are analysed below.

Discharges from the Army on Medical Grounds, 1943-45
Diseases of the Musculo-Skeletal System. Males. Relative Rates

Source: Hollerith Tabulations

1943 1944 1945
Diseases of the Joints:

Synovitis i 4 A 2 i 1°50 1°48 1°78

Arthritis x % : 5 = 11-81 11°87 12°21

I.D.K. . 3 2 74 5 : 5°67 5°86 6-96

Others . Ft e *, 4 rs 4°60 4°24 3°24
Diseases of the Bone . 7 ¥ : 9's! 9°58 9°60
Diseases of the Spine . rs , 11°46 12°42 11-31
Diseases of the Muscles : : . 0°69 0°76 0°68
Diseases of Fasciae, Tendons, Tendon

Sheaths and Bursae $ 0°94 112 "90

Diseases and Deformities of the Limbs:

Infected Fingers. < or or21 0°25

Hallus Valgus, etc. 4°30 2°99 2°91

Hammer Toe 0-19 0°03 0:08

Pes Cavus 5°96 4°24 3°94

Pes Planus 6-12 4°92 6°48

Others . 0°27 0°42 air
Rheumatic Conditions:

Non-Articular ‘ 2. 7 8-42 8-12 9°05

Articular ; s . : 1

Nearly forty per cent. of these discharges were due to RHEUMATIC
CONDITIONS, other than Rheumatic fever. Of these, between one-quarter
and one-third were of the articular type. Both ARTHRITIS and Diseases
of the sPINE were responsible for twelve per cent., while Diseases of the
BONE accounted for nearly ten per cent. each year. Discharges for
INTERNAL DERANGEMENT of the KNEE were some six per cent. of the group
total with Pes PLANUS slightly less.

Discharges on account of TUBERCULOSIS increased annually from 1-2
to 1°5 per 1,000 and were between six and seven per cent. of the group
total. Rates for PULMONARY Tuberculosis were 1-02 per 1,000 in 1943,
1-23 in 1944 and 1-31 in 1945. Those for other forms of tuberculosis
remained stationary at 0-19 per 1,000.

Diseases of the NERVOUS SYSTEM accounted for approximately six per
cent. of all discharges for disease, with rates increasing slightly from
1°13 in 1943 to 1°29 in 1945. The table which follows analyses this
group to component diseases or sub-groups.

442 CASUALTIES AND MEDICAL STATISTICS

Discharges from the Army on Medical Grounds, 1943-45
Diseases of the Nervous System. Males. Relative Rates

Source: Hollerith Tabulations

Sciatica. 5 z 3 14°27 23°36
Other forms of Neuritis : - s 104 2:04
Migraine . Z 5 s . Y 2°75 4°88
Epilepsy . 38°58 28°34
Other Diseases of Uncertain Pathology . 4°25 1°73
Effect Syndrome , 2 1°81 2-01
Diseases of Cerebral Meninges 4 2c1r 2°53
Diseases of the Brain a t ‘i 5°93 5°38
Disorders of Cranial Nerves : a 19°96 16-10
Other Causes. - i s z 9°30 13°63

Between thirty and forty per cent. of discharges in this group were
due to EPILEPSY. Next in numerical importance were disorders of the
CRANIAL NERVES at from sixteen to twenty per cent. and SCIATICA
increasing from fourteen per cent. in 1943 to twenty-three in 1945.
Disorders of the BRAIN were comparatively low at 6 per cent.

Slightly over four per cent. of discharges for disease were attributable
to Diseases of the CARDIO-VASCULAR System, and produced rates at 0-9
per 1,000 strength in 1943 and 1944 and 0-96 in 1945. VALVULAR
DISEASE of the HEART was responsible for one third of the group total in
1943, one quarter in 1944, and one-fifth in 1945 and VARICOSE VEINS for
seven, eight and twelve per cent. respectively.

Next in numerical order of discharges were Diseases of the SKIN,
discharges for which increased from 0-57 per 1,000 in 1943 to more than
double in 1945. An analysis appears in the tabulation below.

Discharges from the Army on Medical Grounds, 1943-45
Diseases of the Skin. Males. Relative Rates

Source: Hollerith Tabulations

1943 1944 1945
Impetigo . é . . . . 1°39 0°73 o°75
Dermatitis Sane Sane on Co 36-90 44°96 48°97
Boils “i . . . 2 . °'79 0°77 0°29
Eczema . a) 5 . * 2 24°62 24°32 18-24
Psoriasis. r . é . 7°39 4°57 6-82
Tinea * : 1°65 Irs T-O1
Diseases of the Sebaceous Glands z. 3°70 4°36 4°32
Diseases of the Sweat Glands and Ducts 1°25 1°32 1°95
Diseases of the Hair and Follicles 5 5°68 5°43 3°86
Other Diseases of the Skin : : 16-63 12°39 13°79

100 100 100

THE ARMY MEDICAL SERVICES 443

The increase in discharges during 1945 as compared with 1943 was
due almost entirely to DERMATITIS which rose from a little over one-third
of the total in 1943 to nearly one-half in 1945. Comparatively high rates
were also attributable to ECZEMA which, with Dermatitis, accounted for
between sixty and seventy per cent. of the group total.

Diseases of the EAR, NOSE and THROAT provided discharges at rates
which increased from 0-72 per 1,000 in 1943 to 0-80 in 1945, and were
between three and four per cent. of discharges for disease. The following
table analyses the statistics of this group.

Discharges from the Army on Medical Grounds, 1943-45
Diseases of the Ear, Nose and Throat. Males. Relative Rates

Source: Hollerith Tabulations

Otitis Media F ey 2 7 2 69°36 65°27
Otosclerosis z s e 5 . 10°67 6°84
Middle Ear Deafness . 5 : 5°02 6-24
Diseases of the Mastoid Process . J 3°80 4°14
Other Diseases of the Ear . 5 . 1°74 2°59
Diseases of the Accessory Sinuses rf 6°71 9°88
Other Diseases of the Nose rt 5 1°27 3°14

Diseases of the Throat

Between eight-five and ninety per cent. of discharges within the
group were due to Diseases of the Ear. As could be expected, OTITIS
MEDIA was responsible for the greater portion of these discharges at
from sixty-five to seventy per cent. OTOSCLEROSIS accounted for about
nine per cent., MIDDLE EAR DEAFNESS for six per cent. and Diseases of
the MASTOID PROCESS under four per cent. Diseases of the NOSE con-
tributed one-tenth of the group total and Diseases of the THROAT under
two per cent.

Diseases of the EYE were responsible for approximately two per cent.
of discharges due to diseases with rates per 1,000 strength which
decreased from 0-45 in 1943 to 0°33 in 1945.

Nearly one half each year were placed under SYMPTOMATIC DIS-
TURBANCES of vision. Among other causes for discharge within this
group were Diseases of the CORNEA, some fourteen per cent., Diseases of
the RETINA about nine per cent. and Diseases of the cHoRoID slightly
lower.

Table 157 records the annual rates per 1,000 strength of discharges of
Male Troops through nyurtEs, while Table 158 cites relative rates.
Discharges increased from 3 per 1,000 in 1943, to 9 in 1945. This
increase is not unremarkable in view of the opening of the Second Front

15CMs*

444 CASUALTIES AND MEDICAL STATISTICS

in Europe in 1944, and the offensive campaign against the Japanese,
culminating in the liberation of Burma and Malaya.

Discharges due to injuries caused through enemy action (E.A.) in
1945 were five times those in 1943 (1°33 per 1,000 against 6-75) while
those not caused through enemy action (N.E.A.) increased only slightly
over the period (1-6 to 2-2 per 1,000). In 1943, the former was forty-six
per cent. of all discharges on account of injury; by 1945 it had risen to
seventy-five per cent.

FRACTURES other than to the head, both E.A. and N.E.A., were
responsible for the majority of discharges and, while rates per 1,000
strength increased in 1944 and 1945, the proportion of E.A. injuries to
the total declined from fifty-one to thirty-two per cent. In contrast, the
proportion of N.E.A. fractures to the whole rose from twenty-four to
fifty-two per cent. A similar situation is witnessed among Head Injuries,
Burns and Scalds, and Old Injuries and is caused by the very large
increase in discharges due to ‘Other Injuries (E.A.)’. These rose from
0:44 per 1,000 in 1943 to 4:04 in 1945 while ‘Other Injuries (N.E.A.)’
decreased from 1-11 to 0-59 in the same period.

The statistics cited above and in the tabulations do not tell the full
story of medical discharges. They do not, for instance, record the varying
DEGREES of DISABLEMENT as shown on discharge documents or, which is
closely related, figures regarding FITNESS for CIVIL EMPLOYMENT.
Neither are any RECOVERY RATES quoted. What follows is an attempt,
in some small way, to furnish this information, in so far as E.A. Injuries
are concerned.

For this purpose an investigation was pursued among data of all
British Other Ranks wounded in North-West Europe during 1944 and
1945, i.e., from the landings in Normandy to the cessation of hostilities.
It was necessary to isolate two classes of personnel, those who died of
their wounds and those who were invalided from the Army because of
their wounds. It was not possible to trace deaths through the medium of
Hollerith tabulations because ‘result on discharge’ (from hospital) had
ceased to be coded. This information was obtainable from another source
and figures relating to degrees of disablement and fitness for civil
employment were obtainable from the Hollerith tabulations.

From the Adjutant General’s Statistical Branch at the War Office
(A.G. Stats.) casualty figures revealed that seven per cent. of all B.O.Rs.
wounded in North-West Europe subsequently died of their wounds.
Thus the chances of SURVIVAL were ninety-three per cent., i.e., ninety-
three per cent. of wounded were either returned to duty or invalided
from the Army with a disability which might, to some extent, affect their
earning power.

From the point of view of army wastage, to this seven per cent. must
be added the invaliding rate. For North-West Europe, the proportion

THE ARMY MEDICAL SERVICES 445

invalided was fourteen per cent. That this is somewhat higher than in
previous campaigns (the figure for the First World War was eight per
cent.) may partly be explained by:

(i) the end of hostilities is likely to have brought with it a relaxa-
tion in the criteria for invaliding,

(ii) the advance of medical science (in e.g. penicillin) in saving the
lives of many who, in other campaigns, would have died, would
increase the proportion of seriously wounded among the
survivors and thus raise the invaliding rate.

Thus, the wastage from the army point of view was:

Deaths . . 7 per cent.
Invalidings 14 per cent.
Total . 21 per cent.

and the recovery rate was therefore seventy-nine per cent.

The question must also be considered from a national point of view.
To do this, allowance must be made for those who, as invalids from the
Army point of view, are still capable of useful employment in civil life.
An analysis of the degree of disablement recorded on discharge documents
is of material assistance in this respect. Of those discharged as invalids

Analyses of Invalidings due to Wounds—North-West Europe—Other Ranks
Degree of Disablement, June 1944-July 1947

Medical Boards in

1. Degree of Disablement Averages|Cumulative
1944 1945 1946 1947
° or 0-0 _ - 0-0 oo
10 og o-"4 o-4 o's o-4 o4
20 2°3 472 3:7 43 3°9 4°3
jo 8-2 13°6 15°3 13°3 12°9 17°2
40 17°9 18°3 18+4 219 18-3 35°5
50 13°9 | 13°4 9°3 11°9 13°0 48°5
60 07 10°3 78 12°4 10°0 58°5
jo 99 74 64 7 7 66-2
80 5*4 44 4°4 4°3 45 JO°7
go 12 08 2 14 o'9 71°6
100 310 27°2 33°1 22°9 28-4 100
Totals 100 100 100 100 100
2. Fitness for Civil Employment
1944 1945 1946 1947 Total
(a) Yes . g x , ~ | 247 19°6 13°3 9°5 19°6
(b) No. . ey , fs 42-4 4'r 34°8 22°4 4o'4
(c) Yes, qualified . : : 32°9 39°3 51°9 68-1 40°0
Totals . : « | 100 100 100 100 100

446 CASUALTIES AND MEDICAL STATISTICS

from the Army on account of wounds received in North-West Europe,
the tabulation shows the relative rates of degrees of disablement.

The higher the degree of disablement, the more restricted is the
occupational scope. If a disability of forty per cent. or less is taken as a
standard for a reasonably wide range of employment, a little more than
one-third of all the invalids fall into this category. As the overall
invaliding figure was fourteen per cent. it may be assumed that approx-
imately five per cent. made a good recovery. This figure, no doubt,
increased as some of those with an initial high degree of disability were
rehabilitated with the passage of time.

In the final analysis, therefore, on the assumptions stated, wastage in
North-West Europe from wounds was approximately:

Deaths ‘ - 7 per cent.
Invalids fit for no, or restricted, civil employment 9 per cent.

Totas . . . . .16 per cent.

The recovery rate was thus of the order of eighty-four per cent.

AUXILIARY TERRITORIAL SERVICE

Tables 159 to 161 relate to discharges from the Army on Medical
grounds of all ranks of the A.T.S. Discharges on account of disease were
20 per 1,000 in 1943, and 21 in 1944 and 1945. They were slightly
higher, by 2 per 1,000, than males in 1943, but lower by 2-5 in 1945.
Apart from a few instances rates varied but little during the three years,
even less than did those for males. Injuries accounted for approximately
two per cent. of all discharges.

The main cause of discharges, as with males, were MENTAL DISORDERS,
rates increasing by 1 per 1,000 to 10°5 in 1945. This compares with an
increase among males by fifty per cent. from 6-2 to 9-4. Discharges for
this group accounted for one half the total for disease. TUBERCULOSIS
which, at 2 per 1,000 accounted for nine per cent. of discharges, was at a
slightly higher rate than for men at 1-4. Diseases of the GENITO-URINARY
System provided rates of discharges which, though not of a high order,
were three times those for males (an average of 1-06 against 0-36).

In contrast, the female rate of 0-7 per 1,000 for discharges due to the
DIGESTIVE System was one-quarter that for males.

SUMMARY

I. MENTAL DISORDERS were responsible for nearly forty per cent. of
discharges for disease among males and one half among A.T.S.

THE ARMY MEDICAL SERVICES 447

2. Discharges due to Diseases of the DIGESTIVE System was of a much
higher order among males.

3. TUBERCULOSIS accounted for a higher percentage of female
discharges.

4. INJURIES negligible among women were responsible for fourteen
per cent. of all discharges among males in 1943 and twenty-eight per
cent. in 1945.

5. The recovery rate from wounds incurred in North-West Europe
was approximately eighty-four per cent.

448 CASUALTIES AND MEDICAL STATISTICS

TABLE 154

Discharges from the Army on Medical Grounds—Males. 1943-45
Annual Rates per 1,000 Strength and Relative Rates

Source: Hollerith Tabulations

1, Rates per 1,000 Strength 1943 1944 1945,
Diseases : E zo 3 17°78 20°76 23°63
Injuries:
E.A. 1°35 3°38 6°75
N.E.A. S 1:60 1°74 2°21
Total Injuries . 4 2°95 5°12 8-96
Total Discharges. , ‘ 20°73 25°88 32°59

2. Relative Rates

Diseases A ; r A 85°77 72°51
Injuries:
E.A. . 55 é é . 6-51 20°71
N.E.A. _ ts 4 : 7°72 6-78
Total Injuries . . 14°23 27°49
Total Discharges.

TABLE 155

Discharges from the Army on Medical Grounds—Males. 1943-45, Diseases.
Annual Rates per 1,000 Strength

Source: Hollerith Tabulations

CAUSES 1943 1945
Mental Disorders : 3 6-24 8-55 9°42
Diseases of the Digestive System | 7 2°76 2°56 3°05
Diseases of the Respiratory System 5 1°39 1°57 1°58
Diseases of the Auscile Skeletal System 1°42 1°40 1°59
Tuberculosis . 3 e re24 1°41 1°50
Diseases of the Nervous System . 113 1°22 129
Diseases of the Cardio-Vascular System o'or 0°90 0°96
Diseases of the Skin . - 0°S7 0°85 1°23
Diseases of the Ear, Nose and Throat | o'72 073 080
Diseases of the Eye . < é 0°45 0°38 0°33
Diseases of the Genito-Urinary Syiera 0°31 0°34 0°44
Rheumatic Fever * . ‘. 0°05 0:06 0:07
All Other Diseases. F : a 0-62 0-79 1°37

Total Discharges for Diseases . 17°78 20°76 23°63

THE ARMY MEDICAL SERVICES 449

TABLE 156
Discharges from the Army on Medical Grounds, 1943-45. Diseases, Males.
Relative Rates
Source: Hollerith Tabulations
CAUSES 1943
1 Diphtheria’ 0-02 1
2 ysentery . 0°07 2
3 lone Catarrhal o-or 3
4 Malaria é : : 0°03 4
5 Meningococcal Infection * . n 0°06 5
6 Pneumonia 0:08 6
7 Rheumatic Fever. 0°30 7
8 Tuberculosis—Pulmonary 5°76 8
9 Tuberculosis—Other fy 109 9
10 Venereal Diseases e rf 0°54 10
ir Other Diseases due to Infection . 0°42 7 a
12 Diseases due to Infestation . Z 0:09 : 12
13 Diseases of the Nervous Syston 6°36 5° 13
14 Mental Conditions 35°08 | 41° 14
15 Diseases of the Eye 2°52 I 15
16 Diseases of the Ear, Nose, and Throat . 4°03 16
17 Diseases of the Cardio-Vascular System . 5°12 17
18 Diseases of the Blood and Blood- forming
Organs ‘ 0°39 18
19 Diseases of the Endocrine System 0°53 19
20 Diseases of the Respiratory System 7°81 20
ar Diseases of the Digestive System . 15°50 1 21
a2 Disorders of Nutrition and Metabolism | 069 22
23 Diseases of the Genito-Urinary Tract . 1°77 23
24 Diseases of the Musculo-Skeletal Syme 7:97 24
25 Diseases of the Areolar Tissue oz 25
26 Diseases of the Skin. * 3 - 3°23 26
27 All Other Diseases a B . 4 0°40 27
28 Total Discharges for Diseases . - | 100 100 28

450 CASUALTIES AND MEDICAL STATISTICS

TABLE 157

Discharges from the Army on Medical Grounds, 1943-45. Injuries, Males.

Annual Rates per 1,000 Strength
Source: Hollerith Tabulations
1. Injuries caused through Enemy Action

CAUSES 1943 1944

Head Injuries f 0°16 0°36
Fractures (other than to the head) 0°69 0-89
Burns and Scalds . e 0°02 0°03
Old Injuries 0°04 o-or
Other Injuries 0°44 2°09
Totals ° ; 4 : 1°35 3°38

2. Injuries not caused through Enemy Action

Head Injuries

Fractures (other than to the head)
Burns and Scalds .

Old Injuries

Other Injuries

Totals

3. All Injuries

Head Injuries

Fractures (other than to the head)
Burns and Scalds .

Old Injuries

Other Injuries

Totals

THE ARMY MEDICAL SERVICES 451

TABLE 158

Discharges from the Army on Medical Grounds, 1943-45. Injuries, Males.
Relative Rates

Source: Hollerith Tabulations

1. Injuries caused through Enemy Action

CAUSES 1943 1944 1945
Head Injuries 4 . 11°63 10°5, 6°33
Fractures (other than to the head) a 51°09 26-2! 32°21
Burns and Scalds ‘ 1°77 0°88 0°99
Old Injuries . ‘: . ‘ 3°00 0°25 0°58
Other Injuries < 5 . 32°51 62°04 59°89

Totals 2 : : > 100 100 100

2. Injuries not caused through Enemy Action

Head Injuries 11°99
Fractures (other § than to the head) 52°32
Burns and Scalds e 5 3°52
Old Injuries 5 2 rs ie 5°22
Other Injuries ‘ < % . 26°95
Totals. : : G 100
3. All Injuries
Head Injuries x 8-29 12°20 7°72
Fractures (other than to the head) 2 36°34 34°42 37°17
Burns and Scalds a . 1°17 1°78 1°62
Old Injuries < : 2 1°63 1°43 1°72
Other Injuries . . . . 52°57 50°17 51°77

Totals 7 . fe * 100 100 100

452 CASUALTIES AND MEDICAL STATISTICS

TABLE 159

Discharges from the Army on Medical Grounds, 1943-45. A.T.S. All Ranks.
Annual Rates per 1,000 Strength and Relative Rates

Source: Hollerith Tabulations

1. Rates per 1,000 Strength 1943 1944 1945
Diseases b ‘, % 19°61 21°13 21°03
Injuries
EA. . : 2 i: é 0°35 0°32 o'55
N.E.A. : 5 z * o'or 0°03 0°04
Total Injuries . : —_ 0°36 — 0°35 0°59
Total Discharges o 5 . 19°97 21°48 21°62

2. Relative Rates

Diseases . a : 98°20 98°37 97°27
Injuries
E.A. : “75 1°49 2°54
N.E.A. _ - . 0°05 orlg org
Total Injuries . 1 —_ 1°63 2°73
Total Discharges a é 100 100 100

TABLE 160

Discharges from the Army on Medical Grounds—Diseases, 1943-45. A.T.S. All Ranks.
Rates per 1,000 Strength

Source: Hollerith Tabulations

CAUSES 1943 1944 1945
Mental Disorders 9°71 10°76 10°52
Tu losis. : . 2°15 2°10 2:07
Diseases of the Nervous System a : 1*20 1°29 1°24
Diseases of the Respiratory System - 0°99 1°22 1°27
Diseases of the Musculo-Skeletal System 0°97 11g 1-21
Diseases of the Genito-Urinary System. 1-08 112 0-99
Diseases of the Digestive System . : °'59 0°70 0:86
Diseases of the Cardio-Vascular Syavem 082 0-56 0°63
Diseases of the Skin 0°44 0°45 o°s1
Diseases of the Endocrine System™ 0°40 0°40 0°44
Diseases of the Ear, Nose and Throat F 0°33 O'41 0°43
Diseases of the Eye . < a 0°25 0°18 orl
Rheumatic Fever 3 S * Or14 re 0°07
All Other Diseases. 7 a 7 0°54 0°64 0:68

Total Discharges for Disease . . 19°61 21°13 21°03

THE ARMY MEDICAL SERVICES 453

TABLE 161

Discharges from the Army on Medical Grounds—Diseases, 1943-45. A.T.S. All Ranks.
Relative Rates

Source: Hollerith Tabulations

Z

1 Malaria. 0°02 1
2 Meningococcal Infection 0°07 2
3 Pneumonia 009 3
4 Rheumatic Fever. : 0°53 4
5 Tuberculosis—Pulmonary 7°97 5
6 Tuberculosis—Other . 1°98 6
7 Venereal Diseases 2 7
8 P.U.O. : é . : _ 8
9 Other diseases due to Infection . 2 . 9
10 Diseases of the Nervous System. . q : 10
Wm Mental Disorders A f ‘ é $ 1
12 Diseases of the Eye. 5 > . +26 = . 12
13 Diseases of the Ear, Nose and Throat . 2 : c 13
14 Diseases of the Cardio-Vascular System . * : : 14
15 Diseases of the Blood and Blood forming
Organs . 15
16 Diseases of the Endocrine System : . : . 16
17 Diseases of the Breast . ci . 17
18 Diseases of the Respiratory System ‘ . . . 18
19 Diseases of the Digestive System . 3 * $ 19
20 Disorders of Nutrition and Metabolism . i “60 20
ar Diseases of the Genito-Urinary Tract . : : 21
22 Diseases of the Musculo-Skeletal System é ‘ 22
23 Diseases of the Areolar Tissue 3 . w : 23
24 Diseases of the Skin . . : . : . 24

25 All Other Diseases x q 5 : Si . 25

The Royal Air Force Medical Services

MEDICAL STATISTICS

by Group Captain S. C. Rexford Welch,
M.A., M.Sc., M.R.C.S., L.R.C.P.

i

CONTENTS

I, ROYAL AIR FORCE

INTRODUCTION

SICKNESS IN THE R.A.F., 1939-45 ,
Table 1. Total Sickness at Home and Abroad .
Table 2. Sickness by Geographical Areas .

SICKNESS AS A WHOLE

Table 3(a). Nosological Table, ‘Gepescaher: 35 ipapcuncose ae 15, 1945
(Total Force)

Table 3(b). Nosological Table, Sepeeenber: 3 ight 15, 1945
(Home) a

Table 3(c). Nosological Table, Bepeichbes 3 ‘cinco 15, 1945
(Abroad) . :

Table 4. Disease Groups in Order of Tiesduse

Table 5. Venereal Disease 1921-45 .

CERTAIN INFECTIOUS DISEASES IN THE TOTAL FORCE, 1939-45
Table 6. Certain Infectious Diseases in the Total Force, 1939-45

DISEASES CAUSED BY INFECTION IN CERTAIN COMMANDS ABROAD,
1939-45 .
Table 7(a). Diseases Gaia ie Infection—India aa A.C. s. E. re
Table 7(b). Diseases Caused by Infection—Middle East
Table 7(c). Diseases Caused by Infection—Iraq
Table 7(d). Diseases Caused by Infection—West Africa

INJURIES .
Table 8. iAcaentiegh Sites of Tiga
Table 9. Burns, 1939-45

INJURIES, 1944 j
Table ro. Injuries, 1944, Total irares 6
Table 11. Aircrew Injuries—G.D. Officers and ‘Airman Ateres Fi

INJURIES—CAUSES
Table 12. Causes of eis 4 1939-45

457

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549
55°
555
556
562
566
568

458 CASUALTIES AND MEDICAL STATISTICS

Page
THE STRENGTH OF THE ROYAL AIR FORCE BY AGE GROUPS,
1939-45 - 569
Table 13. Average Yearly Sticagiha - Specified Age Chobe
1939-45. : ‘ ; : : x ‘ «zt
DISEASES AND INJURY ANALYSED BY AGE GROUPS 572
Table 14(a). Incidence of Sickness and Injury Analysed by Ace
Groups, 1939-45. 574
Table 14(b). Incidence of Diseases a Tajusies by Age Gioups:
Rates per 1,000 of Strength per annum . ‘ : - §83
INCIDENCE OF SICKNESS AND INJURY AMONG OFFICERS,
AIRMAN AIRCREW AND GROUND PERSONNEL, 1939-45 . 587
Table 15(a). Incidence of Diseases in the Various Trade Groups,
1939-41 . A 588
Table 15(b). Inctaesee of Sickness he injary among Officers,
Airman Aircrew and Ground Personnel, 1942-45 . & + 590
FINAL INVALIDINGS IN THE R.A.F., 1939-45 - : : - 595
Table 16. Final Invalidings 1939-45 (War Period). , + §96
DEATHS IN THE ROYAL AIR FORCE, 1939-45 . ¥ : - 598
Table 17. Deaths during the War Period . ; ¢ - 599
II, WOMEN’S AUXILIARY AIR FORCE 601
SICKNESS IN THE W.A.A.F., 1939-45 : : - 601

Table 18. Sickness in the R.A.F. and the W.A.A.F., 1939-45 . 605

SICKNESS AS A WHOLE IN THE W.A.A.F., 1939-45 - , 607
Table 19(a). Nosological Table for Period of Second World War,

September 3, 1939-August 15,1945. . 608
Table 19(b). Number of Fresh Cases, Incidence snd Percents

Distribution of Disease. . . : . 621

Table 20. Certain Infectious Diseases, 1939-45. : : - 622

INCIDENCE OF DISEASE AND INJURY ANALYSED BY AGE GROUPS,

1941-45 . ¢ 5 - 623
Table 21. Diseases and Injuried by Age Gietie. 1941-45 . - 625

THE R.A.F. MEDICAL SERVICES 459

Page
INCIDENCE OF DISEASE AMONG W.A.A.F. OFFICERS AND AIR-
WOMEN, 1942-45 e + 630
Table 22. Incidence of Diseases among Officers ‘iu Aen
1942-45 . : z : A a : 8 ‘ + 631
FINAL INVALIDINGS : : : ‘ - 630
Table 23. Final Invalidings, 1939-45 : : 7 “i - 632
DEATHS, 1939-45 - . ‘ 5 é 7 a - 633
Table 24. Deaths, 1939-45 is ‘i as A : + 633
CHARTS
1. Sickness in the Total Force during the Ten Years, 1936-45 . - 466
2. Number of Sick Daily per 1,000 of Strength at Home and Abroad,
1938-45. - e . 467
3. Average Number of Days Bienes per Head at Home ; and Abroad,
1938-45. - Oe bg egg

4(a). Gonorrhoea—Average Dinko of Treatment i in Days, 1937-45 525
4(b). Syphilis—Average Duration of Treatment in Days, 1937-45 . 526
5. Sickness in the Women’s Auxiliary Air Force, 1939-45 . - 602
6. Women’s Auxiliary Air Force. Number of Sick Daily per 1,000 of

Strength, 1939-45 . : : . : 3 . : - 603

I. Royal Air Force
INTRODUCTION

HE collection of Royal Air Force medical statistics at the outbreak

of war in 1939 was undertaken by Branch M.A.7 of Air Ministry.

In 1941 this function was taken over by the Central Statistical
Branch but this was a change in name only as the methods employed
did not alter.

The system of medical documentation employed in the R.A.F. in 1939
proved as useful under conditions of war as it had been in peace and few
modifications had to be made. These modifications were aimed at
easing the burden on staff and transport, for example, stations and
commands were required to submit monthly summaries of sickness
instead of the weekly returns of peace-time.

It is interesting to note that the Inter-Services Committee on Medical
Documentation which was formed after the war based its recommenda-
tions largely on the existing R.A.F. system.*

The medical documents of each officer and airman were contained in a
Medical History Envelope (Form 48) at the man’s unit. During the
relatively static conditions of peace-time there was rarely a delay of
more than twenty-four hours between the arrival of a man at a new unit
and the receipt of his Medical History Envelope. During war-time, with
a vastly increased force and an overloaded communications system, there
was often a considerable delay between the man’s arrival and the receipt
of his medical documents. Medical officers, however, usually had a
complete record of a man’s medical history available eventually. One
fault of the system was that the Medical History Envelope carried no
record of minor but often significant illnesses not requiring admission
to sick quarters or hospital; all such ailments were recorded in the
station sick book at Sick Parade. (Since the war the sick book has been
superseded by Treatment Cards for the recording of minor illnesses and
these cards accompany the rest of a man’s documents.)

Many Service patients admitted to station sick quarters or hospitals
were suffering from minor illnesses for which civilian patients would be
treated at home, but with which the airman could rarely remain sick in
quarters. These cases of forty-eight hours’ duration or less werenot fully
documented but brief notes on diagnosis and treatment were made in
the sick book. Exceptions to this rule were made in certain diseases, such
as gonorrhoea, which, though requiring only a very brief in-patient
treatment, were nevertheless of special interest. Patients were classified

* The system of documentation for W.A.A.F. personnel was identical with that
described here for the R.A.F.

461

462 CASUALTIES AND MEDICAL STATISTICS

as (1) ‘admitted’—i.e. in hospital or sick quarters or sick at home for
more than forty-eight hours; (2) ‘detained’—i.e. in sick quarters for
forty-eight hours or less; and (3) ‘excused duty’—i.e. merely offduty and
not necessarily in sick quarters.

For cases which were admitted all records were prepared in triplicate.
A manuscript copy (Form 41) was prepared in the first instance by the
medical officer and from this were typed a card copy and a flimsy copy
(Forms 39). The original manuscript copy was retained at the unit, the
flimsy copy was inserted in the Medical History Envelope (Form 48)
and the card copy forwarded to Air Ministry.

The cards on arrival at Air Ministry were analysed on to coding
slips from which Hollerith machine cards were punched. Numerical
codes were used for everything—trades, age groups, Commands,
disposal, disease, etc.

A source of error in the collection of R.A.F. medical records resulted
from the admission of R.A.F. patients to Emergency Medical Services
(E.M.S.) hospitals. Many outlying units relied almost entirely on E.M.S.
hospitals for the treatment of patients and, of course, survivors of air
crashes were taken to the nearest hospital, civilian or Service. Men taken
ill when on leave and requiring hospital treatment were usually admitted
to civilian hospitals. Many of the latter were over-burdened and under-
staffed and it was obviously asking too much to expect them to conform
to the varied and complicated systems of medical documentation
required by the Services.

It is also obvious that human error or enemy action prevented some
medical cards from reaching Air Ministry.

Before and during the war period the R.A.F. used its own Disease and
Injury classification (which is therefore used in this publication); the
International Statistical Classification of Diseases, Injuries and Causes
of Death (W.H.O.) was adopted in 1948 and came into use in 1950.

Statistical classification has always been a difficult problem and
attempts at improvement have been continuous since the first Inter-
national Congress in Brussels in 1856. Criticism may therefore be
levelled at the war-time system of coding. For instance, only the
principal disease leading to admission was coded and no allowance was
made for complications of the disease or for secondary disease or injury.
Difficulties and inaccuracies in such a method spring to mind. A man
admitted with lacerations develops tetanus; is he classified as an injury
or as a case of tetanus? A man under treatment for a depressive psychosis
takes an overdose of phenobarbitone; is he classified as a psychosis or as
an attempted suicide? Again, no differentiation was made between
admissions for fresh diseases and recurrent admissions for the same
disease. Thus it is right that a man admitted several times during the
year for the common cold should represent so many fresh cases of the

THE R.A.F. MEDICAL SERVICES 463

common cold, but if a man were admitted several times during the year
for recurrent episodes of peptic ulcer pain then his classification each
time as a fresh case gives a false impression of the incidence of peptic
ulcer. This is a common statistical problem and although the R.A.F.
has made attempts to remedy it by secondary tabulations, auxiliary
codes, etc., no satisfactory solution has as yet been found.

Parallel with the collection of cards and flimsies was the system of
summaries of sickness submitted by all stations to their Commands,
weekly at first, but later monthly (Form 38); the Commands consolidated
these and forwarded them to Air Ministry. These records showed the
number of admissions for each particular disease, the number of days
spent in hospital or sick quarters and the final disposal of the patient.
From these unit records the Principal Medical Officer at Command
Headquarters was able to form an up-to-date picture of the health of the
Command as a whole. Any undue incidence of a particular disease
could be noted and possible preventive measures taken. There was but
slight delay in the receipt of these Command records by Air Ministry
and a fairly accurate summary of the health of the Royal Air Force was
available at any time.

From the medical cards Air Ministry prepared annual reports on the
health of the R.A.F. and the W.A.A.F. It is from the tables in these
annual reports and from the general library of medical record cards that
the present statistical survey has been prepared. For the years 1944 and
1945, when the strength of the R.A.F. was over one million and when
staffing problems at Air Ministry were acute, it was found impossible to
prepare statistics for the whole force and a ro per cent. sample was
taken, except for figures relating to deaths and medical boards, all of
which were examined. The sampling was done by analysing the medical
records of every officer and airman who had o as the last figure in his
Service number; the sample, of course, was large enough to make error
insignificant.

These statistics provide the basis for medical planning. They show
the trend of diseases, major sources of wastage, the efficacy of different
types of treatment and the need for special prophylactic measures.
‘They give now an accurate picture of the health of a known population
in defined age groups under known conditions. It is admitted that we
are ignorant of morbidity rates in large populations and that our social
medicine is founded on mortality statistics. For the country as a whole
an attempt has been made to remedy this by analysing certificates of
incapacity for work. This covers the whole of the working population,
both employed and self-employed. There are, however, inherent
inaccuracies in this scheme of collecting statistical data which do not
apply to the R.A.F. system. The figures are based on claims for benefit
supported by a doctor’s certificate. This cannot be a confidential

464 CASUALTIES AND MEDICAL STATISTICS

document and is not designed to be an accurate diagnostic record.
In many instances doctors are reluctant to disclose a grave diagnosis to a
patient. Illness causing absence from work of less than four days does
not make the patient eligible for benefit. Ministry of Health surveys
have shown that 94 per cent. of illness is of less than four days’ duration
and that more than three-quarters of those with such illness do not
consult their doctors.

But, above all, the following tables show how important a part was
played by the medical services in maintaining the R.A.F. as a fully
effective fighting force throughout the war and in all parts of the world.
Throughout history battles have been won and lost and armies decimated
through disease and epidemics. In the South African War typhoid
affected more than a quarter of the British Army and over eight thousand
men died as a result; dysentery may fairly be said to have been one of
the most important causes of failure of the Gallipoli campaign in the
War of 1914-18. In the Second World War, however, medicine at last
was in the ascendant over disease.

THE R.A.F. MEDICAL SERVICES 465

Sickness in the R.A.F., 1939-45

Sickness in the Royal Air Force for the war period 1939-45 is
analysed by geographical areas in Tables 1 and 2.

The word sickness used in this report includes disease, accidents and
wounds,

The geographical areas included under the heading ‘Mediterranean
Littoral’ in Table 2 are Aden, Egypt and North Africa, Kenya, Malta,
Palestine and Trans-Jordan and the Sudan; Italy was included in this
group from 1943. Units based in France and Germany in 1944 and 1945
are included under the ‘Force at Home’.

The first section of each table is an analysis of all cases of sickness
where treatment meant absence from duty, i.e. excused duty, detained
in sick quarters for forty-eight hours or less, or admitted to hospital or
sick quarters for over forty-eight hours. It does not, of course, refer to
all those who were seen and treated on the daily sick parades but who
were able to carry on with their duties. The second section of the tables
analyses cases of over forty-eight hours’ duration.

Final invalidings and deaths are also recorded in these tables.

A comparison of sickness rates in pre-war days with those during
war-time is interesting and Chart 1 shows sickness in the total force
during the ten years 1936-45. Before the war the R.A.F. was a small,
compact and reasonably static force living under relatively good con-
ditions. Every man was a volunteer and morale and discipline were of a
high order. The peace-time expansion to meet the German threat was
more than adequately catered for in the construction of suitable
permanent accommodation at the new stations. It is not surprising,
therefore, that sickness rates for the years 1936-39 show a steady and
progressive decrease, and it would have been reasonable to expect a
considerable increase in sickness rates under war conditions. There was
a rapid increase in strength with men drawn from all walks of life.
Peace-time standards of accommodation went by the board.* There was
often serious overcrowding and the floor space allowed per man in a
barrack room or hut had to be reduced from the peace-time standard of
60 sq. ft. to 32 sq. ft. Many men had to live in tents and the temporary
huts, erected by a building industry whose resources were strained to
the utmost, were often inadequate, draughty and ill-ventilated. Black-
out restrictions added severely to the problems of ventilation. The
policy of dispersal of buildings used as a counter-measure to the threat
of bombing resulted in men having long walks through the open to reach
working areas, dining halls and washhouses. The need for fuel economy
meant that only rarely were there adequate facilities for drying damp

* See R.A.F. Medical Services Vol. 1. Accommodation, pp. 356-358, 362.
+ See R.A.F. Medical Services Vol. 11, No. 60 Group, pp. 665-667.

466 CASUALTIES AND MEDICAL STATISTICS

CHART I
R.A.F. SICKNESS IN THE TOTAL FORCE
DURING THE TEN YEARS, 1936-45

Incidence

per 1,000

per annum
800

NESS UNDER
S. DURATION

Lda

SICKNESS OVER
48 HRS. DURATION

1936 1937 1938 1939 1940 1941 1942 1943 1944 1945

clothing. The problems of feeding large numbers with existing facilities
and of providing an adequate diet were considerable. Sewage disposal,
particularly on new sites far from existing civil sewerage services, was
another big problem and many instances are recorded of sewerage
plants being dangerously overloaded. Increased hours of work and the
added strain and fatigue of war-time duties were further hazards to
health. Added to this, the first winter of the war in 1940 was very
severe.

THE R.A.F. MEDICAL SERVICES 467

Sickness rates did rise in 1940 but in view of the circumstances the
rise was surprisingly small. The total sickness incidence reached a peak
for the ten year period at 798 cases per 1,000 of strength which compares
favourably with the 1936 figure of 750 cases per 1,000 of strength.
Sickness of over 48 hours’ duration in 1940 was at the rate of 435 cases
per 1,000 of strength which was, in fact, slightly lower than the 1936
rate. In 1941 sickness rates fell considerably and the figure for all
sickness of 636 cases per 1,000 of strength was lower than for any of the
pre-war years mentioned. Sickness of over 48 hours’ duration at 382
cases per 1,000 of strength was lower than the rates for 1936 and 1937.
Thereafter, there was a steady rise in sickness rates to 1944 when the
total figure was 764 cases per 1,000 of strength and the figure for cases
of over 48 hours’ duration 551 cases per 1,000 of strength. This can be
correlated with the larger percentage of men serving overseas; the
sickness rates for the force at home do not show the same trend. In 1945

CHART 2
R.A.F. NUMBER OF SICK DAILY PER 1,000
OF STRENGTH AT HOME AND ABROAD, 1938-45

Rate per

1,000 of HOME Wg ABROAD
Strength | Z,

40

1939

468 CASUALTIES AND MEDICAL STATISTICS

TABLE 1
TOTAL FORCE
to30t | 1940 | 1041 | 1942 | 1943 1944 94st
Average Strength | 140,862| 324,398] 662,772] 860,747| 971,439] 1,002,593 | 933,922
TOTAL SICKNESS
Number of Cases. 5 96,649] 259,01 421,576 568,130] 708,494) Tee 79 | $72.212
Incidence per 1,000 of strength | 686) 798 36] 660 729] 764 13
Average duration in days of each case returned to
duty. . 8.2] a 9's o's o's 10°8 10°0
Average number of days sickness a head ¢ 5:6) 6- 6 ‘3 6-9) 7:9) 8-8 6-8
Number of sick daily per 1,000 of strength . 15°4| 18-7] ee 19-0] ars 24°2 18-7
*SICKNESS (excluding cases of 48 hours and under)
Number of Cases. $0,276] 141,170] 253,225| 370,388) 483,81 $52,303 | 397,644
Incidence per 1,000 of strength | 357 435 382| 43 Sst
Average duration in days o! ‘each case returned to
duty . a 14°4] 145 1g"r * 14) a ey
Average number of days sickness, per head : $'s 3 6-1 6- 7s 8- 6
Number sick daily per 1,000 of strength 14°1 ae 16°8 18-1 20°7 23°s 18-1
Cases of sickness of 48 hours and under . 46,373) 117,845] 168,351] 197,742] 224,681) 213,776 | 174,568
FINAL INVALIDINGS
Numbers 1,173] 3,497] 10,017) 12,875} 13,181) 15,177 | 17,940
Incidence per 1,000 of strength - 8-3] 10°8| Is‘) 15°0) 13°6 19°C 1972
INVALIDINGS TO THE UNITED KINGDOM
Numbers . . . - = aa — - _ =
Incidence per 1 000 of strength | si ¥ % — | —| — -
DEATHS
Numbers . . . 950] 6,343] 9,892] 12,973] 18,625
Incidence per 1,000 of strength | 5 i . 6-7] 19°6) 149] 1g't 19°32]

* Includes cases resulting in death or invaliding irrespective of duration.

+ The whole year.
there was a considerable fall to 613 cases per 1,000 of strength for all
sickness and to 426 cases per 1,000 of strength in sickness of over
48 hours’ duration. The tonic effect of winning the war must have
contributed largely to this, accompanied, as it was, by a general improve-
ment in living conditions and the lessening of operational demands.

Chart 2 records the number of sick daily as rates per 1,000 of strength
at home and abroad during the years 1938-45. In other words it
represents the average daily wastage of man-power from disease and
injury. In the force at home there is surprisingly little difference
between the rate for 1938 and that for the war years. Abroad, there was
a steady increase in the number of sick daily from 23 cases per 1,000 of
strength in 1939 to 35 cases per 1,000 of strength in 1944, with a fall
to 25 cases per 1,000 of strength in 1945. (See Table 1.) This increase
in the number of sick daily is largely attributable to the expansion of
the R.A.F. in the Far East where the problems of tropical medicine are
at their greatest. For the force in the Mediterranean Littoral the peak
year was in 1941 with a decline in the number of sick daily after that.
(See Table 2.)

Chart 3 records the average number of days sickness per head before
return to duty, at home and abroad, for the years 1938-45. At home the
average was greatest in 1940 when it was 6-0 days and in 1944 when it
was 6-9 days. Abroad there was a steady increase from an average of

THE R.A.F. MEDICAL SERVICES 469

R.A.F. Total Sickness at Home and Abroad

FORCE AT HOME FORCE ABROAD

1930f

1940 1941 1942 1943 1944 1945t | 1939T | 1940 | 1941 1942

80,866| 227,871] 327,174] 322,584] 345,699] 386,660] 293,770] 15,783, 34.744) 940402 245,546] 362,795] 379,419] 278,442
559] 490] $22) 565] += 460] gos} 982]

123,430] 292,668] 584,924] 658,334] 662,600] 683,816] 639,269] 17,432] 31,730] 77,848| 202,413] 308,839) 318,777] 204,653

779] 1,213] 1,213] 1,175) 1,190) 945
8-4) 9°6] 10°3] 0-6] rx] ore 4] 9-6] 8-8 8-3 8-8] grr 8-r
6s} so} 5-6 59) 7:9) S +5] 974] 10° 1x3] 12° 12:8] g-2
1779] 16-2) 1§+3] 16-3] r9°2] 45-8] 23-2) 25-7] 29° 31-0] 33° 35°1| agcr

123,160] 202,520] 228,350] 267,632| 311,927] 232,518| 8,891] 18,010] 50,705] 142,038 216,181] 240,376] 165,126
5] 4an 346) 347 404) 456} 364) sto) 568) 651 jo2] Joo] 754) 560
14°3 1g-2| 15 1 1s 1 1g's| 15° 14°5) 1 1. 14] I
JE yh el eg ea al ot al atl od

16-5} rS-4) 14°7] 158] 18+ 15's] 2x°7] 2471] 27-9] 29°0) 31°89 33°S) 23-7

104,711] 124,654] 94,234| 78,067| 74,733] 61,252] 6,892| 13,134] 43,697,

103,508] 146,614] 139,043] 113,316

3,398] 9,908) 12,477] 12,286] 13,489] 16,267] 8 99] 109 1,679
11-6) 16-9 19°0| 18-5 19°7 25-4! ro a 14 3°7
5554:
843
2,117

5.229] 8,113] 9,896] 15,030] 16,278] 5,641 122] 1,114)
17°Q} -13°9} tS°0) 22-7] 238 8-8) E Bs

7°9 days in 1939 to 12-2 days in 1944 with a fall to 8-6 days in 1945.
(See also Table 1.) Again this is correlated with the increasing size of
the R.A.F. in the Far East.

During the war when the number of civilian hospital beds often
proved inadequate to deal with the demand, criticism was occasionally
levelled at the R.A.F. policy of maintaining a large number of beds and
retaining patients for long periods. The explanation, of course, is that
all R.A.F. patients had to be kept in hospital or sick quarters until they
were completely fit for duty and life under rigorous conditions. The
development of medical rehabilitation units and convalescent units did
much to ease the demand on hospital beds, but Service medical officers
were very rightly reluctant to return men to duty when they were still
semi-convalescent.

The various causes of invaliding are analysed in Table 16 and
discussed in the section relating thereto (page 595). The considerably
higher incidence of invaliding from the force at home is a result of the
system of retaining all men with limited medical categories in the
United Kingdom; obviously, men with past histories of medical
complaints tended to make up the majority of invalidings.

The high incidence of invaliding in 1945 was a natural concomitant
of victory. Men who were content to suffer their disabilities in the
National interest during the war years realised in 1945 that herein lay

470 CASUALTIES AND MEDICAL STATISTICS

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472, CASUALTIES AND MEDICAL STATISTICS

CHART 3

R.A.F. AVERAGE NUMBER OF DAYS SICKNESS
PER HEAD AT HOME AND ABROAD, 1938-45

Wi home ABROAD

No. of days

borderline cases when the end of the war was in sight. (See R.A.F.
Medical Services Vol. III, India and Far East, pp. 629-633, 694.)

the opportunity of quick release to civilian life and the avoiding of the
tedious process of group demobilisation. It is also probably true to say
that the invaliding medical boards tended to take a more lenient view of

THE R.A.F. MEDICAL SERVICES 43

SICKNESS AS A WHOLE

Tables 3a, 3b and 3c are the main nosological tables analysing the
incidence of diseases and injuries for the Royal Air Force as a whole and
for the Commands at home and abroad. The tables show diseases in
groups according to the system of the body in which the main lesion is
present and the groups are further divided on an anatomical or patho-
logical basis; in some instances individual diseases have been specified.
The group of infectious diseases shows the more important tropical
diseases separately and the remainder, with the exception of infections
of the nervous system, are recorded under the type of organism causing
the infection.

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THE R.A.F. MEDICAL SERVICES 521

In Table 4 below the disease groups are arranged in order of incidence
and for each group the number of cases, the incidence per 1,000 of
strength and the percentage of the total diseases are shown. This table
is for the total force over the whole war period and summarises the
relative importance of the various disease groups according to the
number of cases but does not, of course, compare the number of man-
hours lost from each cause.

TABLE 4
R.A.F. Disease Groups in Order of Incidence

Disease Group

Upper Respiratory Tract Infections
Other Infectious Diseases .
Alimentary System

Septic Conditions ‘

Indefinite and General :
Respiratory System (trachea, bronchi,

lungs, pleura) . % hs

E.N.T.

Locomotor System a

Nervous and Mental Diseases

Venereal Diseases .

Generative System
_Circulatory System

Urinary System

Eye < a
Pneumonia

lergy

Cysts and Tumours |
‘Tuberculosis (Pulmonary) | a
Tuberculosis (Other Sites) .
Endocrine, Blood and Metabolism

Totals

COODOH HH mn WWddaD

INFECTIOUS DISEASES

The diseases at the head of this group which are chiefly of importance
in tropical countries (amoebic dysentery, bacillary dysentery, enteric
fever, enteritis and malaria) are dealt with in Section D relating to
the tables of diseases caused by infection in certain Commands abroad
(Tables 7(a), (b), (c), (d)).

Of the remainder, the incidences of the more important infections
are shown in Table 6—‘Certain Infectious Diseases in the Total Force
1939-45’. These diseases are discussed in the narrative attached to that
table.

522 CASUALTIES AND MEDICAL STATISTICS

BACILLARY INFECTIONS, other than typhoid and dysentery, include
diphtheria, tetanus, whooping cough and anthrax. These diseases
never assumed great importance during the war.

VIRUS INFECTIONS refer to the common diseases of measles, rubella,
mumps and chicken pox and others such as smallpox, herpes and
psittacosis. The high incidence of 24 per 1,000 of strength in 1940 is
largely accounted for by an epidemic of rubella which affected the
whole country at that time.

The heading INFECTIONS OF UNKNOWN OR DOUBTFUL ORIGIN covers
such diseases as rheumatic fever, glandular fever, infective hepatitis
and Weil’s disease.

CENTRAL NERVOUS SYSTEM INFECTIONS includes cerebro-spinal fever,
anterior poliomyelitis and the various forms of encephalitis.

INFECTIONS OF THE UPPER RESPIRATORY TRACT

Infections of the Upper Respiratory Tract were responsible for more
than 25 per cent. of sickness due to disease. The common cold heads
the list with an average incidence of 44 per 1,000 of strength and peak
incidences in 1940 at 58 per 1,000 of strength and in 1943 at 53 per
1,000 of strength. It must be remembered that these figures refer only
to cases sufficiently severe to require admission for 48 hours or more
and are no measure of the true incidence of the common cold. In 1944
the average duration of treatment before return to duty at home and
abroad was six days compared with an average of eight days for
influenza.

It was feared that war-time conditions would favour the development
of influenza epidemics but these expectations were belied by experience.
There was moderate epidemicity in the United Kingdom in 1940 and
again in 1943 but in 1944 the number of influenza deaths in the country
was the lowest since 1919. The incidence of influenza in the R.A.F.,
too, was highest in 1940 and 1943. Although the lowest incidence is
recorded for 1945 this does not refer to a complete year; the lowest
incidence in any complete year was in 1944. The incidence of influenza
was slightly higher at home than abroad.

PNEUMONIA

This term includes all forms of pneumonia—those of bacterial origin
and those due to non-bacterial agents, known or unknown. The chief
point of interest is the high incidence in the force at home in 1944 when
it was over 7 per 1,000 of strength or roughly double the incidence for
other years. During that year there were 6,542 cases with 30 deaths.
The average period of treatment before return to duty was 26 days.
This may possibly be regarded as the aftermath of the influenza
epidemic which occurred in the December quarter of 1943.

THE R.A.F. MEDICAL SERVICES 523

Apart from 1944 the incidence of pneumonia abroad did not differ
significantly from the incidence at home.

TUBERCULOSIS

The Registrar General’s reports show that during the pre-war years
from 1935 there had been a progressive decline in tuberculosis morbid-
ity. In 1939 there was an arrest of this downward trend, a considerable
increase in 1940-41, a return to the 1938-39 level in 1942-43 and a
resumption of the downward trend thereafter.

R.A.F. experience of tuberculosis did not parallel that of the com-
munity at large. Pulmonary tuberculosis shows an incidence which
gradually rises to its highest level of 2-1 per 1,000 of strength in 1943.
There was a fall to 1-4 per 1,000 in 1944 but the incidence again rose
to 1-8 per 1,000 in 1945. The incidence for types other than pulmonary
remained fairly steady throughout with an average incidence of 0-4
per 1,000. The mortality rates were highest in 1940 and 1942. (See
Table 17.)

Probably the chief reason for the difference between R.A.F. and
civilian figures was the increasing use made by the R.A.F. of mass
chest radiography during the war. (See R.A.F. Medical Services Vol. I,
Chap. 6, p. 288 ff.) Chest radiography for recruits was not a routine
procedure in the R.A.F. at the start of the war. The first mass radio-
graphy unit was presented by the British Red Cross in 1941 and gradually
other units were acquired. This meant that in the later years of the war
the majority of recruits and many serving personnel had routine chest
X-rays. Many cases of active tuberculosis were brought to light and
its importance in eliminating foci of infection and in avoiding the
expense and danger of training unfit and potentially infective men was
obvious.

There was no significant difference between the incidence of tuber-
culosis at home and abroad. In 1939 and 1940 there were too few men
abroad for the figures to be strictly comparable. In 1941 and 1942 the
incidence was practically the same at home and abroad. In later years
the incidence was higher at home than abroad—this was probably due
to the discovery of cases by mass radiography prior to posting overseas.

VACCINIA AND POST-INOCULATION EFFECTS

During the war every recruit was offered vaccination against smallpox
and inoculation against the typhoid and paratyphoid group and against
tetanus. Efforts were made to maintain this immunity by re-vaccination
at specified intervals and by yearly booster doses of T.A.B.C. and
A.T.T. Protection against yellow fever and cholera was given to
personnel posted to or passing through districts in which these diseases

524 CASUALTIES AND MEDICAL STATISTICS

were endemic. The constitutional upset from T.A.B.C. inoculation was
often severe enough to lead to admission to sick quarters. Vaccination
against smallpox carried with it the risk of generalised vaccinia and the
occasional risk of post-vaccinial encephalitis. In the early years of the
war a number of cases of inoculation jaundice were caused by yellow
fever inoculation with a vaccine prepared from pooled serum. Reactions
to tetanus toxoid and cholera vaccine were rare.

CARRIERS AND CONTACTS

Treatment of carriers and contacts of infectious diseases caused a
small but steady wastage during the war years. A measure of their
importance is given in the 1945 statistics when 200 carriers spent an
average of 24 days under treatment and 120 contacts an average of
17 days. The important diseases likely to be spread by symptomless
carriers are cerebro-spinal fever, diphtheria, the dysenteries, cholera
and enteric fevers, Diseases requiring the isolation of contacts included
those mentioned above and others such as anterior poliomyelitis,
smallpox and the common infectious fevers.

SEPTIC CONDITIONS

This group includes boils, carbuncles, abscesses, cellulitis, finger
infections and lymphadenitis. As would be expected, the incidence
abroad was about double the incidence at home—residents in tropical
countries are particularly prone to septic infections.

VENEREAL DISEASES*

The peace-time incidence of venereal diseases in the R.A.F. at home
was low and had fallen steadily since 1921. This low incidence has been
attributed very largely to improved education, ample facilities for
sport and frequent and regular home leave and to the fact that the bulk
of R.A.F. personnel consisted of healthy, well-educated artisans with
interesting work to occupy them.

It was anticipated at the outbreak of the war, with its rapid recruit-
ment of men from all walks and conditions of life, that the incidence of
venereal diseases would rise steeply. The lack of recreational facilities
at many stations, the uncertain and reduced periods of leave and the
irregular and increased hours of work would all tend to be factors
leading to an increased incidence. In fact, the incidence of venereal
diseases for the force at home does not show any marked rise until
1944, when the increase was almost entirely due to the inclusion of the
Allied Expeditionary Air Force and the Air Forces of Occupation as

Pog R.A.F. Medical Services Vol. I, Chap. 7, p. 399 and Vol. III, Chap. 11,
Pp. 670.

THE R.A.F. MEDICAL SERVICES 525

home commands. Table 5 summarises all venereal diseases from 1921-
45-

Gonorrhoea

The figures represent all cases of gonorrhoea treated during each year
and include all relapses and all sequelae of gonococcal infections. At

CHART 4(a)
R.A.F. GONORRHOEA—AVERAGE DURATION
OF TREATMENT IN DAYS, 1937-45

Duration of
treatment
in days

80

70

60

50

40

30

20

1937 1938 1939 1940 1941 1942 1943 1944 1945

526 CASUALTIES AND MEDICAL STATISTICS

home, the incidence of gonorrhoea rose but slightly between the years
1939-43 but thereafter showed a marked increase. Overseas the incidence
was always considerably higher than at home. The highest rate was
in the small force overseas in 1939 when many men were serving in
France. The lowest rate in the overseas forces was in 1941 when a large
part of the force was in the Western Desert and opportunities for con-
tracting venereal disease were limited. Thereafter there was a steady
increase in incidence.

Venereal disease incidence is always higher abroad than at home and
several factors play a part in this difference; the greater opportunities
for sexual intercourse, the high rate of infection of the local populations,
the absence of home moral ties, separation from family and the know-
ledge that diagnosis and treatment can easily be concealed from families
at home.

The most dramatic fact about gonorrhoea was the reduction in the
average duration of treatment of each case (Chart 4(a)). In 1937 this
was 74 days for the R.A.F. as a whole. By 1943 with the rapid advances

CHART 4(b)
R.A.F. SYPHILIS—AVERAGE DURATION OF TREATMENT
IN DAYS, 1937-45

Duration of
treatment
in days

50

40

30

20

1937 1938 1939 1940 1941 1942 1943 1944 1945

THE R.A.F. MEDICAL SERVICES 527

in the use of sulpha drugs in the treatment of gonorrhoea this figure
dropped to 18 days. With the advent of penicillin the average duration
of treatment was further reduced to 16 days in 1944 and 10 days in 1945.

Syphilis

Syphilis showed the same general trend in incidence as gonorrhoea—
at home, a slowly increasing incidence up to 1943 and then a more rapid
jump. Overseas the incidence was always higher than at home, with the
lowest rate in 1941. The average duration of treatment is shown in
Chart 4(b).

ALIMENTARY SYSTEM DISEASES

Diseases of the alimentary system showed a marked increase in
incidence from 30 per 1,000 of strength in 1939 to 61 per 1,000 in 1944.
This compares with an incidence of 27 per 1,000 in the five years before
the war. The group ‘other intestinal conditions’ is mainly responsible
for this increase. This miscellaneous group includes colitis in its various
forms, diverticulosis and diverticulitis, the non-specific diarrhoeas and
intestinal obstruction. The increase in incidence occurred mainly in the
force abroad in the years 1943-45 but was also noticeable in the home
force.

Peptic ulceration

In the civilian population of this country it has been estimated that
some ten per cent. of the male population suffer or have suffered from
peptic ulcers; of these, however, comparatively few appear to be
chronic invalids and most manage to carry on, many probably settling
into sheltered occupations. It was generally agreed before the war that
peptic ulceration was a bar to service in the Armed Forces and most
cases of proved ulceration were invalided. During the war this policy
was modified and a larger proportion of cases returned to duty. This
proportion was largest in the R.A.F., for two reasons; firstly, because the
proportion of skilled technicians is high and every attempt was made to
keep these valuable men; secondly, because the possibility of placing
these men in sheltered appointments and even allowing them to live
in their own homes was greater in the R.A.F. than in the other Services.

Peptic ulceration was not a major problem in aircrew before the war
because of the care with which they were selected. A history suggestive
of peptic ulceration or of recurring indigestion was a cause of rejection
of candidates for flying duties.

Before the war the invaliding rate for peptic ulceration in the R.A.F.
was just over 3 per cent. of those discharged for all diseases. By 1943
this figure had risen to 17 per cent.

528 CASUALTIES AND MEDICAL STATISTICS

The return to duty of pilots who have had peptic ulceration is gradual
and many months with complete freedom from symptoms must elapse
before a full flying category can be regained. Before the war, after a full
course of treatment and convalescence, the patient was kept on ground
duty, usually for nine months. After this period, which was nearly a year
from the original illness, limited flying was allowed, the limitations
usually being for height and duration of flight. A ceiling of 8,000 feet
and flights of not more than two hours’ duration were the limitations
usually imposed. A full flying category was allowed after a further
6-12 months. During the war these periods were often cut down but
in every case a gradual return to flying duty was recommended.

A survey was made in 1943 of the prognosis of cases of peptic ulcer
returned to duty in the R.A.F. (Air Cdre. Rook, Lancet, June 12, 1943).
Included in the survey were 26 members of aircrew. After roughly two
years about half of them had returned to some form of flying duty, nine
of them having regained full flying category. One of these was an officer
whose gastric ulcer had perforated while he was flying alone; he man-
aged to land safely and, after treatment, returned to flying duties.

There were 17,775 cases of peptic ulceration and their complica-
tions admitted during the war period, 1939-45. It is simpler to dis-
cuss these conditions as a whole under the heading ‘peptic ulcers and
their complications’ than to discuss gastric ulcers and duodenal ulcers
separately. Of these cases, 128 died and 9,279 were invalided from the
Service. Theaverage incidence over the period was4 per 1,0000f strength
per annum and the incidence rose steadily from 2-8 per 1,000 in 1939
to 4:4 per 1,000 in 1945. The average number of persons under treat-
ment each day during the whole period was 265 with the peaks at 36 in
1939 and 404 in 1944. The average number of days under treatment
was 34 so that the total man-power lost during the period was 692,988
days. This figure takes no account of the number of days off duty for
sick leave or convalescence.

No valid comparison can be made between the incidence at home and
abroad as personnel with a history of gastric symptoms would be un-
likely to be posted abroad.

Duodenitis

This was a diagnosis based on radiological findings. It was chiefly
an irregularity of the rugae and spasm without a detectable ulcerative
lesion.

CIRCULATORY SYSTEM DISEASES

Heart disease is a much smaller problem in Service medicine than in
civilian practice because of the selection of fit people from a limited

THE R.A.F. MEDICAL SERVICES 529

age group. Inevitably, some case of congenital and rheumatic heart
disease are missed at the initial medical boards but the numbers are
never large. Degenerative vascular disease is also comparatively in-
frequent.

In the light of the experience of the First World War extensive pre-
parations had been made to receive cases of disordered action of the
heart and the relatively small numbers encountered came as a surprise.
In 1944, the peak year, there were 765 cases of a total strength of over a
million. It is probable that very much less overt attention was paid to the
cardiac manifestations of psychoneurosis in 1939-45 than in 1914-18
and this avoided the development of cardiac fixations. Symptoms such
as headache, depression and amnesia became more common. A rough
estimation has shown that for the Services as a whole casualties from
cardio-vascular causes, organic and functional, in the Second World
War were approximately one-fiftieth of the numbers in the War of
1914-18.

DISEASES OF BLOOD VESSELS

Two important but quite unrelated conditions viz. hypertension and
varicose veins, have unfortunately been classified under this heading and
account for the vast majority of cases of diseases of the circulatory
system. There was a progressive rise in incidence during the war years
and in 1945 the incidence reached 5 per 1,000 of strength.

RESPIRATORY SYSTEM DISEASES

This group does not include pulmonary tuberculosis, the pneu-
monias or bronchial asthma. Diseases of the lung refer to such condi-
tions as lung abscess, pulmonary collapse, emphysema, pulmonary
embolus, pneumokoniosis, etc. Diseases of the pleura include all forms
of pleurisy, pleural effusion and empyema and also pneumothorax and
haemothorax.

The incidence of respiratory system diseases for the total force rose
gradually to a peak in 1944, when there were 25 cases per 1,000 in the
force at home and 18 per 1,000 abroad. In 1939 the incidence in the
force abroad was 23 per 1,000 but this was out of a relatively small
number of just over fifteen thousand personnel, many of whom had to
live through the very severe winter in France.

A large proportion of diseases of the respiratory system is accounted
for by bronchitis. The increase in the incidence of bronchitis is paralleled
by the increase in the incidence of pneumonia. The unsuitability of the
chronic bronchitic for service in tropical climates was often demon-
strated during the war. Eventually such cases nearly always break down
even if free of symptoms for a long period.

530 CASUALTIES AND MEDICAL STATISTICS

All cases of pleural effusion have been placed in this group without
regard to aetiology. It is certain that many of these later proved to be
due to pulmonary tuberculosis.

DISEASES OF ALLERGY

Bronchial asthma never proved a serious problem and the annual
incidence never rose above 2 per 1,000 of strength. The incidence was
rather higher at home than abroad. Urticaria, in common with other
skin affections, was commoner abroad.

URINARY SYSTEM DISEASES

The classification ‘Anomalies of urinary secretion’ refers to conditions
such as albuminuria, haematuria, glycosuria, etc. in which abnormal
constituents are found in the urine. Uraemia is classified under nephritis.
Kidney discases distinct from the nephritic group include hydro-
nephrosis, perinephric abscess, pyelitis and amyloid disease.

The investigation of symptomless cases of albuminuria, particularly in
selection for aircrew, involved a considerable amount of wasted time.
Often in the early years of the war men were admitted to hospital and
submitted to a series of unnecessary and time-consuming investigations
when simple tests as out-patients for orthostatic albuminuria would
have proved sufficient.

Nephritis was uncommon and no particular correlation with strep-
tococcal infection can be recorded.

Urinary calculi and urinary colic were more common in those serving
abroad. Relative dehydration from excessive sweating in hot climates and
often a diminished fluid intake were probably the chief factors in this
higher incidence. Renal complications of the less soluble sulphonamides
were occasionally seen when these drugs were first introduced.

GENERATIVE SYSTEM DISEASES

Urethritis in the War of 1939-45 presented a considerable problem
in the number of cases that were frequently called non-venereal but
were more correctly non-gonococcal. These are included here. Clinically
these cases ranged from a mild anterior urethritis to severe purulent
infections often involving the posterior urethra and prostate. Patho-
logically, the causes were believed to include ordinary mixed organisms
such as staphylococci and streptococci, trichomonas infection, Ritter’s
syndrome and possibly pleuropneumonia organisms.

Diseases of the penis were more common abroad than at home. As in
other skin diseases, service in the Tropics with excessive sweating and
under poor hygienic conditions would lead one to expect an increased
likelihood of balanitis.

THE R.A.F. MEDICAL SERVICES 531

LOCOMOTOR SYSTEM DISEASES

Diseases of muscles are an unimportant group and include myositis,
dermatomyositis, the myopathies and myositis ossificans.

The diseases classified under the rheumatic group are fibrositis,
myalgia, pleurodynia, lumbago, muscular rheumatism, torticollis and
lumbosacral strain.

Deformities include malformations of the spinal column, deformities
of feet and toes and conditions such as Dupuytren’s contracture.

Diseases of joints include all forms of arthritis, acute and chronic,
and prolapse of intervertebral discs.

Internal derangement of the knee joint refers only to tears of the
menisci; this, however, caused a considerable wastage of man-power,
chiefly due to the length of time spent in hospital or convalescent unit
following meniscectomy. The injuries were normally contracted when
playing football.

Articular rheumatism

The chronic ‘rheumatic’ diseases proved a steady form of wastage in
the R.A.F. during the war as, indeed, they do in any medical practice
nowadays. Acute varieties of articular rheumatism and rheumatoid
arthritis were uncommon, but the vague categories of chronic rheu-
matic disorders had a high nuisance value. There were, of course, wide
disparities in nomenclature, diagnosis and treatment and a detailed
breakdown of the group would serve no useful purpose. The general
opinion is that the precipitating factors were febrile illness, trauma and
severe cold, but there is no doubt that the persistence of symptoms was
often an expression of an underlying anxiety state. There existed a
psychological problem very similar to that seen in peptic ulcer patients;
physical examination was often not sufficient in doubtful cases and fur-
ther investigation sometimes showed the patient’s belief in the organic
basis of his complaint to be unfounded.

NERVOUS SYSTEM AND MENTAL DISEASES

In the First World War all the emphasis was placed on physical
fitness as the essential attribute of the pilot. Flack’s tests and similar
methods controlled the selection of candidates. Although the nature of
fear and anxiety was recognised undue emphasis was placed on material
factors; it was always regarded as important to discover an organic
cause and such unfortunate terms as ‘shell shock’ and ‘disordered action
of the heart’ were coined. In the period between the wars we had begun
to learn the lesson that too much stress was being laid on physical
efficiency and not enough on the psychological aspect. It is incredible
what disabilities a man can overcome if he has the right temperament

18CMs

532 CASUALTIES AND MEDICAL STATISTICS

for a war pilot; men have flown while undergoing treatment with arti-
ficial pneumothorax or after thoracoplasty. At the same time there are
many apparently fit men who have been quite unable to stand up to the
strain of flying.

Psychoneuroses ranged from cases of severe depressive states ad-
mitted to hospital to those with milder anxiety states and the psycho-
somatic group with peptic ulcers, low back pain or asthma. Headaches
and ‘blackouts’ were also common. Psychoneurosis which could be
attributed to fear and flying stress was found among aircrew and the
incidence was, not surprisingly, greatest among the operational com-
mands. It was highest in night bombers and lowest in Flying Training
Command; emotional tension proved more important than physical
fatigue. (See R.A.F. Medical Services Vol. II, pp. 122-36 and Medicine
and Pathology Chapter XV.) But the number of psychoneuroses
which could be directly attributed to combatant conditions or fear was
small and there was no significant difference in total incidence of
psychoneuroses between aircrew and ground personnel. The precipi-
tating cause was obvious enough—the dislocation of normal life, separa-
tion from wife and family, Service discipline and the learning of new
occupations. Many of the men had long histories of previous instability
but did not break down until removed from the shelter and seclusion
of home life.

The incidence of psychoses showed little significant change from year
to year. Although the onset in a number of cases was accelerated by
war conditions the true causes were found in the patients’ past histories.

The incidence of psychopathic personalities showed a progressive
rise during the war years, presumably correlated with the urgent need
for expansion and the consequent less strict selection of recruits. The
heading includes emotional instability, immature personality and
psychological inferiority as well as the more obvious behaviour dis-
orders.

Nervous system diseases of indefinite aetiology included airsickness,
headache, migraine, enuresis, tic and vertigo.

In their investigations into Psychological Disorders in Flying Personnel
of the R.A.F. (H.M.S.O. 1947) Air Vice Marshal Sir Charles Symonds
and Wing Commander Denis Williams included an investigation of the
Psychological Aspects of Airsickness. Their broad general conclusion
was as follows:

‘When a man is suspended for airsickness at any stage of training the
cause is usually motion sickness uncomplicated by psychological
factors. Psychological factors—either neurosis, neurotic predisposi-
tion or faulty morale—may contribute by lowering the physiological
threshold for tolerance of motion or by reducing a man’s ability or

THE R.A.F. MEDICAL SERVICES 533

willingness to endure symptoms, but psychological abnormality may
co-exist with airsickness without contributing to it. As a cause of
suspension for airsickness psychological factors are seldom of major
importance. Psychological factors are never the direct cause of true
airsickness which should be clearly distinguished from visceral re-
actions to anxiety occurring in the air.’*

ORGANIC NERVOUS DISEASES

As would be expected there is little variation in the incidence from
year to year.

The heading ‘indefinite organic diseases’ includes disseminated
sclerosis, the muscular dystrophies, myasthenia gravis and Parkinson’s
disease.

EYE DISEASES

Inflammatory conditions of the eye were more common abroad than
at home. Conjunctivitis was sometimes apparently due to non-specific
causes and was not uncommon in the desert, owing largely to exposure
to sun, wind and sand. In the humid climates of the Far East much of
the conjunctival trouble was due to sweat, dirt and dandruff.

EAR DISEASES (See Section on Oto-Rhino-Laryngology in the
‘Surgery’ volume in this series)

Chronic suppurative otitis media constituted the chief cause of aural
morbidity. In the majority of cases the condition was present prior to
entry into the R.A.F. and very often little or no comment on the aural
condition was made by the National Service Medical Boards. Personnel
already in the Service and trained or partly trained were treated on con-
servative lines and kept under close specialist supervision. These men
were a liability when sent overseas and although efforts were made to
grade them for home service only many were still posted to Commands
abroad.f Untrained men were usually invalided. Flying personnel with
active C.S.O.M. were taken off flying. Following treatment they were
allowed to fly in a non-operational capacity as long as the condition
remained inactive.

Otitis externa was more common overseas than at home. In the Middle
East irritation by wind and sand was a potent cause. In the Far East
otitis externa or ‘tropical ear’ was a considerable problem and often
proved intractable to treatment.

* See also R.A.F. Medical Services Vol. I, pp. 120-22.

+ It was considered by many medical officers that such men should have been
debarred from serving even in certain United Kingdom Units, where conditions

aggravated their complaint. (See, for example, the section on the Outer Hebrides, in
the R.4.F. Medical Services Vol. II, p. 240.)

534 CASUALTIES AND MEDICAL STATISTICS

Surprisingly few ear injuries resulted from non-fatal flying accidents.

Otitic barotrauma was an important cause of non-effectiveness
among flying personnel. This is the syndrome resulting from inability
to adjust intratympanic pressure on descent from higher altitudes. The
outstanding contributory factor was found to be an upper respiratory
infection giving rise to Eustachian tube insufficiency. The condition was
responsible for loss of ‘man-flying hours’, recategorisation, limitation
in flying category and often cessation of flying.

SKIN DISEASES

Statistics for cases of skin diseases requiring admission for 48 hours
or more do not give a true picture of the incidence of these conditions.
Most cases of skin diseases are treated as out-patients and only a few
of the more serious call for admission.

Scabies was the most common skin disease and rose to an incidence
of 11 per 1,000 of strength in 1941-42. In 1943 there was a considerable
fall in incidence to 5 per 1,000 and in 1945 the incidence was only 2
per 1,000. The incidence was higher abroad than at home. Treatment
with benzyl benzoate came into general use in 1942 and this probably
accounted for the fall in incidence; treatment with sulphur had been
attended by a high rate of relapse and complications. It is interesting to
note that scabies had shown a progressive rise in incidence in the pre-
war years:*

1935 1936 = 1937S: 1938—1939f = 1940
Scabies Ir 2-0 28 370 4:2 6°5
Impetigo 44 48 51 53 5:2 40

Tinea, all types 4-4 55 74 39 2°5 18
(Incidences are shown as rates per 1,000 of strength.)

In warm climates echthymatous sores were a constant source of
trouble and caused a serious loss of efficiency. They were variously
described—desert sores in the Middle East, jungle sores in the Far
East. The aetiological factor appeared to be loss of resistance of skin
devitalised by exposure to sun, wind and dust, frequently coupled with
inadequate ablution facilities.

Tinea and other fungus infections were very common in tropical
countries due to excessive sweating and irritation by clothing. There was
a great tendency to diagnose tinea without adequate proof, clinical or

* See also R.A.F. Medical Services Vol. II. p. 580, ‘Free from Infection Inspec-
tions’,

t These figures, of course, do not coincide with those shown in Table 3(a) which
refer only to the one period rather than the complete year.

THE R.A.F. MEDICAL SERVICES 535

microscopical, and many harmless skin conditions were converted into
chemical dermatoses by over-enthusiastic fungicidal therapy.

Pediculosis was never very prevalent in the R.A.F. during the
war. The conditions which made infestation almost universal in the
trenches in the First World War rarely occurred in the War of 1939-
45.

Impetigo was another serious form of wastage, particularly overseas.
It is a disease which often occurs in epidemic forms in communities of
men living together.

Seborrhoeic dermatitis is a common and troublesome condition in
war-time. Nervous and anxiety states, limitation of protein and pro-
tective foods and restricted facilities for personal hygiene are the
aggravating factors.

536 CASUALTIES AND MEDICAL STATISTICS

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THE R.A.F. MEDICAL SERVICES 537

CERTAIN INFECTIOUS DISEASES IN THE
TOTAL FORCE, 1939-45

Table 6 shows the incidence per 1,000 of strength of the more
important infectious diseases other than the tropical diseases.

TaBLe 6
R.A.F. Certain Infectious Diseases in the Total Force, 1939-45

Incidence per 1,000 of strength

DISEASES 5 years
average
1940-44
Acute anterior
poliomyelitis o1 oun o'os 0-08 o-2 o-3 or or
Acute rheumatism 23 ar 1'6 12 0-8 m2 o's 4
Infective hepatitis
(catarrbal jaundice) 1g 2 a4 sr 11-6 12°) 70° 6-5
rebro-spinal fever or mr o7 °3 o-2 o2 or os
Chicken-pox re | oo | og | o og | 13 0:8 10
Diphthena o3 os o o7 o 13 os o8
Encephalitis lethargica 0-03 0°03 0-02 o-o2 0°006 | o'0s 0-002 | 0°03
G meas 33 20°6 a 1-8 18 42 0-6 6-3
Measles rt 21 'y o-7 er 06 os o2
lumps 3 Ir rs 29 iy 1 2°5 16
Scarlet Fever 23 2-2 wr 10 r 1" o-4 16
mallpo: Nil oor o-or 0-02 oor o-2 S.c8 0:06
‘Tetanus oror Nil 0-005 0-005 Nil Nil Nil 0-002
Typhus o-or oor o-or 0-03 0-08 o1 oz 0-05

ACUTE ANTERIOR POLIOMYELITIS

This disease never proved a great problem in the R.A.F. during the
war and there were only small epidemics.* The highest incidence was
in 1944 when there were 0-3 cases per 1,000 of strength.

ACUTE RHEUMATISM

A study of Acute Rheumatic Fever in the R.A.F. in 1940 and 1941
has been published (Barber, H.S., 1946, Brit. Med. J. 2. 83). Rheumatic
fever has for long shown a decline both in incidence and severity. The
War of 1939-45 caused no increase in its incidence but it is still an
important cause of morbidity in large communities of young adults.
The disease is traditionally associated with exposure to damp and chill
but when these conditions are met with in great severity in war-time
they cause no noticeable increase in the incidence of the disease unless
associated with upper respiratory infections. In the R.A.F. Apprentice
Schools the condition has always been a source of anxiety and in 1940
the incidence among boy entrants and apprentices rose to over 10 cases
per 1,000 of strength. This can be related to the epidemic of upper
respiratory infections in the winter of 1940. The incidence in the total
force in 1940 was 2:1 per 1,000 of strength, the highest recorded for
the war period. (See Medicine and Pathology Chapter IV.)

* See R.A.F. Medical Services Vol. I, p. 320.

538 CASUALTIES AND MEDICAL STATISTICS

INFECTIVE HEPATITIS

This was of chief importance in the overseas theatres and is discussed
in the narrative relating to Tables 7(a), (b), (c), (d)—‘Diseases Caused
by Infection in Certain Commands Abroad’.

CEREBRO-SPINAL FEVER

During the War of 1914-18 cerebro-spinal fever assumed epidemic
proportions throughout the country but rapidly abated after the end of
the war. Towards the end of 1939, with the concentrations of recruits,
mass movement of population and the problems of overcrowding and
poor ventilation, it was expected that similar or even greater outbreaks
would occur. In 1940 there was, in fact, a severe epidemic in Great
Britain and it appeared that the disease would be a major problem in
subsequent years. But happily, although prevalence remained higher
than in peace-time, there were no further serious outbreaks. The in-
cidence in the R.A.F. in 1940 was 1-1 per 1,000 of strength. (See
Medicine and Pathology Chapter VI.)

GERMAN MEASLES

The high incidence of rubella in 1940 corresponded with a nation-
wide epidemic.

SCARLET FEVER

The Registrar General’s report shows that for the country as a whole
the incidence of scarlet fever declined in the period 1939-41; it then
increased to epidemic proportions in 1943, with some regression in 1944.
This experience was not paralleled in the R.A.F., where the highest
incidence was 2:2 per 1,000 of strength in 1940. There was a fall in
incidence in 1941 and 1942, but a further rise in 1943 and 1944.

SMALLPOX

There were only 27 cases of smallpox in the United Kingdom during
the war and all R.A.F. cases occurred abroad. The highest incidence
was in 1944 when there were 0-2 cases per 1,000 of strength. Most
cases occurred in India where, in certain areas such as Bengal, the
disease is endemic.

MEASLES

There was a severe epidemic in the United Kingdom during 1940
and 1941, followed by a decline in 1942 and a recrudescence in 1943.
A similar trend is observed in the R.A.F. figures.

THE R.A.F. MEDICAL SERVICES 539

TYPHUS

There was a severe outbreak of epidemic louse-borne typhus fever
in Egypt in 1942 among the civilian population. About 22,000 cases
with some 5,000 deaths were recorded but this certainly does not
represent the true extent of the epidemic. Only seven cases with three
deaths occurred among R.A.F. personnel.

18*CMS

540 CASUALTIES AND MEDICAL STATISTICS

DISEASES CAUSED BY INFECTION IN CERTAIN
COMMANDS ABROAD, 1939-45

The principal diseases caused by infection in certain Commands
abroad are recorded in Tables 7(a), (b), (c) and (d). The Commands
are India and A.C.S.E.A. (Air Command South-East Asia, formed in
1943), Middle East, Iraq and West Africa. Diseases in other important
areas overseas, such as South Africa and Canada, have not been analysed
as conditions there more closely resembled those at home.

AMOEBIC DYSENTERY

Amoebic dysentery is endemic in many tropical and sub-tropical
countries and is especially common in districts where sanitation is
deficient. Its control is essentially one of efficient hygienic measures.
Epidemics of the disease have occurred, notably in the British Army
in Gallipoli in 1915.

There were 870 cases of amoebic dysentery recorded for the force at
home during the war years, and it may be assumed that many of these
infections were contracted during service abroad, but it is of interest to
note that a small epidemic of amoebic dysentery has been recorded in
an R.A.F. station in this country since the war, many of the victims
never having served abroad.*

Altogether, over 10,000 cases of amoebic dysentery were recorded in
the total force and as the disease often runs a protracted course this
represented a very considerable wastage. In 1943, for instance, the
average period of treatment before return to duty was 36 days. In 1944
there was an incidence of 13 per 1,000 of strength in the force abroad.
The R.A.F. in India and South-East Asia suffered most heavily, and
there the incidence rose steeply to 36 per 1,000 in 1944. The year 1944
was also the peak year in Iraq (25 per 1,000) and in the Middle East
(8 per 1,000). 1945 saw a considerable fall in incidence in all three
Commands,

BACILLARY DYSENTERY

Bacillary dysentery has always been a common cause of wastage in
armies in the field. Out of 30,000 British soldiers who fought in the
Crimea 7,883 suffered from dysentery and of these 2,143 died. In the
South African War there were 38,108 cases with 1,342 deaths. In the
R.A.F. in the Second World War improved hygienic measures and the
discovery that sulphonamide drugs have a marked action on dysentery
bacilli made it possible to avert major outbreaks of the disease and to
bring about rapid cure of most cases which came under early treatment.

* See B.M.J., 19th July, 1952, p. 114-16. Indigenous Amoebiasis, a Recent Outbreak
in England by Morton, T. C., Stamm, W. P. and Seidelin, R.

THE R.A.F. MEDICAL SERVICES 541

There were nearly 32,000 cases altogether but the mortality was very
low.

A distinction is made in Table 7(a), (b), (c) and (d), between cases
where the Shigella organism had been isolated from the faeces and
cases which were diagnosed on clinical grounds alone. The ease of treat-
ment with sulphaguanidine enabled medical officers to treat dysentery
without the necessity for pathological investigation of the faeces. Indeed,
very many mild cases treated early must have gone unrecorded. It is safe
to say that the diagnosis was less frequently made and less regularly
controlled by laboratory studies than in the First World War. This was
largely due to the necessity for treating operational personnel in for-
ward areas immediately and the almost invariable lack of microscopes
to examine faeces.

In the R.A.F. at home there were sporadic outbreaks of a minor nature
but the fact that only 1,764 cases were recorded for the war period is a
tribute to the standard of hygiene. Abroad, where hygienic control was so
much more difficult and where the disease is so widespread among the
local populations, bacillary dysentery presented a serious problem.*
The R.A.F. in India and South-East Asia suffered heavily and in
1942 the incidence rose to 53 per 1,000 of strength. There was a fall in
1943 to 40 per 1,000 but again in 1944 a rise to 53 per 1,000. Sulpha-
guanidine first began to be used in 1942 and this probably explains the
decreased incidence in 1943. 1944 saw a considerable expansion in the
Far East Air Force and many units had to live under unsatisfactory
sanitary conditions in forward areas.

In the Middle East the incidence rose sharply to a peak of 44 per
1,000 in 1941 but had fallen to 27 per 1,000 in 1943. In 1944 there was
a slight rise to 33 per 1,000 but 1945 saw a big drop to 12 per 1,000.

ENTERIC FEVERS

Prophylactic inoculation and improved standards of hygiene have
greatly reduced the importance of typhoid and paratyphoid fevers.
In the R.A.F. there were only 1,845 cases during the Second World
War and this provides a remarkable contrast to the British Army in
the South African War when there were 57,684 cases with 8,022 deaths.

The majority of cases occurred abroad and there were only 136 at
home. A few outbreaks occurred in India in units close to villages where
typhoid was endemic. Isolated cases were contracted by drinking water
from unauthorised supplies and by eating in local cafés.

ENTERITIS

This term was used to cover a wide variety of acute episodes of
diarrhoea and vomiting and such conditions as ‘Gippy tummy’, Isolated

* See R.A.F. Medical Services Vol. III, pp. 100, 104, 666-68.

542 CASUALTIES AND MEDICAL STATISTICS

attacks of gastro-enteritis accompanied by profuse diarrhoea with
passing of blood and mucus, lasting 24-48 hours, often occurred in the
desert. Such attacks were considered inevitable among new arrivals.
In many cases the attacks had little effect on general well-being but in
others there was marked prostration.

At home the highest incidences were in 1940 and 1941 at 6 per 1,000
of strength, while after 1942 the incidence was always less than 1 per
1,000. Abroad the incidence was high from 1939-42 and then fell sharply
for the remaining years. It is possible that the introduction of sulpha-
guanidine accounts for this fall in incidence in 1943; many mild cases
of enteritis previously requiring admission would be effectively treated
with sulphaguanidine. This enormous drop in incidence is reflected in
the figures for the four Commands overseas.

MALARIA*

Owing to its world-wide distribution and endemicity in most warm
countries malaria is the most common of human diseases in peace and
war. The clinical effect of malaria in war-time is no more severe than
in peace-time and no new aetiological factor is introduced, but various
factors tend to increase the morbidity from the disease. The introduc-
tion of large numbers of non-immunes into endemic areas frequently
gives rise to serious epidemics. Personal protection and preventive
measures are often difficult in the mobile conditions of war. Air trans-
port and the movement of large bodies of men may introduce malaria
into previously non-malarious areas.

In the War of 1914-18 of all the diseases responsible for non-
effectiveness malaria easily took first place. In the British Army alone
the admissions to hospital for malaria were almost half a million.
Although a greater measure of control was possible in the R.A.F.
during the Second World War there was still a total of nearly 75,000
cases. In India and the Far East in 1944 malaria accounted for 17 per
cent. of all diseases, in the Middle East in 1940 for 10 per cent. of all
diseases and in West Africa in 1942 for 55 per cent. of all diseases.
Much of this wastage was preventable and was due in no small measure
to the failure of the executive in the early stages of the war to realise
that malaria discipline required their active co-operation. It was often
difficult for the R.A.F. to select camp sites of low malaria risk because
the primary consideration was to find a level stretch of ground for a
landing strip and the best of such sites were often in low lying, marshy
districts. In many instances dress discipline was poor, officers and men
bathed after dusk and failed to carry out other precautions such as the
use of repellents and mosquito nets. Prophylactic mepacrine was often
not taken consistently. The work of malaria control squads was not

* See R.A.F. Medical Services Vol. III, Chaps. 7 and 11.

THE R.A.F. MEDICAL SERVICES 543

regarded with the importance which it should have been accorded and
men of low grade and poor intelligence were usually assigned to such
work. Eventually, malaria control was made the direct responsibility
of the unit commander and the considerable fall in incidence in 1945
was due to the subsequent close attention to every detail of malaria
control.

The use of mepacrine was one of the greatest steps forward during
the war. It permitted campaigns to be fought and won which could
not have been fought successfully without it and malaria came to be
regarded in forward areas as less of a major hazard.

At home 5,077 cases of malaria were recorded but these refer to men
who contracted their infections, primary or recurrent, when serving
abroad.

For the force overseas as a whole the worst years were 1943 (76 per
1,000) and 1944 (75 per 1,000). There was a considerable fall in 1945
to 31 per 1,000. In India and South-East Asia the peak was in 1944
with 157 per 1,000, in the Middle East in 1940 and 1941 with 60 cases
per 1,000 and in Iraq in 1944 with 83 per 1,000. In West Africa in 1942
there was an incidence of 844 cases per 1,000 of strength in a force
just over 5,000 strong.

In the Far East benign tertian malaria was consistently more common
than malignant tertian malaria whereas in the Middle East in 1940 and
1941 the malignant form was the commoner of the two.

In the later years in the Middle East benign tertian malaria showed a
slightly higher incidence. P. falciparum, the parasite of malignant
tertian malaria, is confined to the warmer regions of the earth and is
found especially in the hot, dry desert countries with a limited water
supply. In North Africa it was the commonest form encountered. In
West Africa the infections were predominantly malignant tertian.
Quartan malaria, as has always been the experience, was rare in all
commands.

INFECTIVE HEPATITIS

Epidemics of jaundice have occurred in every war but it is impossible
to decide whether the epidemics in earlier compaigns were due to
infective hepatitis, Weil’s disease or other factors. Many of the cases of
jaundice which occurred in the armies in France and Flanders in the
War of 1914-18 were due to Weil’s disease but there was no epidemic
of this disease during 1939-1945. Infective hepatitis reached epidemic
proportions in some units of the British Army in the Middle East during
the War of 1914-18. During the Second World War infective hepatitis
became extremely widespread among forces in the Mediterranean
region and caused an enormous wastage of man-power. In the Northern
Hemisphere epidemics start in the late summer, reach their peak in

544 CASUALTIES AND MEDICAL STATISTICS

mid-winter and die down in the spring. This seasonal swing was seen
in the Mediterranean where there were four large epidemics—two in
the Middle East Forces at the end of 1942 and 1943 and two in the
Central Mediterranean Forces at the end of 1943 and 1944. In India
the seasonal incidence appears to vary on the two sides of the country
in keeping with the monsoons.

The Army experienced its heaviest outbreaks in the Mediterranean
region and there particularly among the front line troops. Although
the R.A.F. experienced a high incidence in the Middle East the rate
was actually higher in India and the Far East. Both areas had peak
incidences in 1944 when there were 44 cases per 1,000 of strength in
the Far East and 35 cases per 1,000 of strength in the Middle East.
Iraq shows a parallel rate with the highest incidence in 1944. In West
Africa the highest rate was 35 per 1,000 in 1943. (See Medicine and
Pathology Chapter IX and Appendix p. 267 and R.A.F. Medical
Services Vol. III, pp. 101, 127, 134, 190, 285, 425, 509, 680.)

PHLEBOTOMUS FEVER

Phlebotomus fever or Sandfly fever is widely distributed in Africa
and Asia and in the Tropics it may break out at any time as an epidemic
among new arrivals; in the sub-tropics it occurs principally during the
summer and early autumn. Natives of endemic areas appear to be
immune.

In the Far East Forces the highest incidence was in the early years of
the war and there was a notable falling off in later years. The force in
Iraq suffered heavily and in 1941 the incidence there was 317 per 1,000
of strength. Here, too, there was a fall in incidence in the later years of
the war and in 1944 there were 42 cases per 1,000.

UPPER RESPIRATORY TRACT INFECTIONS AND INFLUENZA

Upper respiratory tract infections were no less important abroad than
at home and even in tropical areas a consistently high sickness rate
was recorded.

THE R.A.F. MEDICAL SERVICES 545
TABLE 7(a)
R.A.F. Diseases Caused by Infection, India and A.C.S.E.A.,* 1939-45
Incidence per 1,000 per annum
1939 | 1940 | 1941 | 1942 | 1943 | 1944 1945
‘DISEASES
Dysentery:
Clinical primary . . 30 6-3 is8 23°8 14°30 16-63 15°69
Bacillary primary . . * 96 10°6 18-3 29°2 25°45 36°60 29°97
Amoebic primary fe * o's ro, 24 17-1 23°62 35°58 17°94
Recurrent. . - _ o's o7 ir o°51 0:07 o-4t
Totals. a I3-k 19°0 | 37:0 | 71-2 | 63°88 89:78 | 64:00
Enteric grou
‘Typhoid fe fever Fs ro os _ I's 0-92 1°59 0°86
Paratyphoid (A. B. and C:) iz — o's = og og O'S4 ol?
Clinical enteric - os a _- hr | 100 110 0°35
Totals. 15 10 = 32 2:07 3°23 1-38
Enteritis 23:7: | 38:1 57°9 | 30°7 1°89 gun 5°52
Malaria:
Clinical . . . gro 42 3:0] 23e1 20°78 19°64 gi
Quartan . . . — os O-3 o7 0°36 ont 0-0}
Benign tertian™ . . . 26-3 20-1 21-7 Sat Orig 74°90 18-95
Malignant tertian . . . 40 6-9 6-4 332 25°68 30°37 TBR
Recurrent . . . 40 13°3 2"4 6 26°45 30°37 4°97
Blanket treatment | ¥ 1°72 18
Totals. . 39°3 | 46°0 | 33-8 | 118-7 | 134-41 Is7-11 | 40°20
Infective hepatitis (catarrhal
jaundice) 2 é = me i 23°52 32710 4414 19°67
Pyrexia of uncertain origin | an 16 34 6-0 S24 4°93 8-04
Phlebotomus fever 1] 28-3. | 40-7] 44:0] 2t-9 | 10-26 10°51 5°44
Influenza . . rae 14°3 8-5 16-6 6-40 4°83 173
Upper respiratory tract infections | | 67-5 | 72-5 | 72-2 | 80-5 | 77-04 102-88 | 68-43
Tuberculosis, all types 25 1°6 14 2-2 1°75 1°74 2°42
Venereal diseases z 15°2 16°4 18- 36:0 31°70 38°34 32°19
Other infections 5 11-6 | 30-7 | 2771 | 94°5 | 56°97 69°83 | 38-50
All diseases caused by infection and
xia of uncertain origin 202-7 | 281°9 | 303°9 | 504-7 | 423°71 530°43 | 287°52
All other diseases and unclassified
conditions . . . « | 202-2 | 205-1 | 212-0 | 351-7 | 314755 407°46 | 322°29
Totals of all diseases 404°9 | 487°0 | 515-9 | 856-4 | 738-26 937°89 | 609-81
INJURIES
General injuries | 88] 8:5] 28] 129] tyos agor | 19°35
I injuries 58's | S69 | 48-1 38°6 | 28°54 38-19 | 34cr
Totals of all inguries 67-1 | 65°44] ss-9 | st-s | 42°58 62-20 | 53°53
Totals of all diseases and inguries . | 472°0 | 552-4 | 571-8 | 907-9 | 780-84 | 1000-09 | 663-34

* A.C.S.E.A. was formed in November 1943.

546 CASUALTIES AND MEDICAL STATISTICS

TABLE 7(b)

R.A.F. Diseases Caused by Infection, Middle East, 1939-45
Incidence per 1,000 per annum

1939 | 1940 | 1041 | 1942 | 1943 1944 1945
DISEASES
Dysentery: |
Clinical primary . . 13 sa 17'S | 149 6-62 7°54 3°20
Bacillary primary aa 4°7 | 11-6 | 26-2] 22-7] 20-49 25°34 | 9-04
‘Amoebic primary Aili ea rol 24] 28 $°23 3 2°55
Recurrent . - or 0-3 os Ce org o-t4
Totals. > G0} 17°8 | 46-4] 40°9] 32°46 | 41-45 | 14°93
Enteric grou
‘Typhoid o2| on 4 16 1°23 1-94 1°99
Paratyphoid (A. B. and C.). oz = o4 o2 0°40 0°85 Or14
Clinical enteric . os ey 0°73 03 0:43 | 0°85 0-97
Totals. O90 og a4 21 2°06 3°64 3710
Enteritis 39°4 | s0°4 | 69°8 | 26-2 6°28 797 s'1s
3 : ae 2s | 16:8] 13:8] 6-3 6-76 | 4:98 1-81
Quartan i. - . . O4 ou og oz 0°09 ial ==
Benign tertian = 14°2 1576 13°73 20°4 17°86 15°38 572
Malignant tertian . 35 17°6 26-9 ou 16-11 11°70 4°59
Recurrent ae ee 21] 10-1 6-0 15 6-23 on 2°24
Blanket treatment: : -|- - = - _ _- o'ss
Totals. 28°7 60-2 60°4 37°5 47°05 4n17 14°48
Infective hepatitis (catarrhal
jaundice) - . =. is 16°2 221 24°94 34°83 11°30
Price of uncertain origin |! 39 -4{ 8-7] 4:9] 15-61 | 22-07] 20-17
Phlebotomus fever . ee | org | 246 #9 42:2 | 29°07 | 28-04 9:18
Influenza. LON —" | 2g-2] t-8] 12-2] 8-20] 9:68 | 1-67
Upper respiratory tract infections 100°! 95°4 96°83 85's 85-7 107-19 67°76
Tuberculosis, alltypes . mr tr mr o 3:2 3°00 1°84
Venereal diseases . : i 31-0 | 26-3] 21-3] 13-8 | 12-31 | 22-99 | 18-04
Other infections 7:6 | 27°6 | 35:4 | 17-7] 20°52 | 3r-ss | 13-24
All diseases caused by infection and
pyrexia of uncertain origin 233°2 | 342°9 | 418°9 | 306-9 | 287°51 | 353°63 | 181°76
All other diseases and unclassified
conditions 246°5 | 256-1 | 278-5 | 266-3 | 277°78 | 328-00 | 209-01
Totals of all diseases 479°7 | 599°0 | 607°4 | 573°2 | 565-29 | 681°63 | 390°77
INJURIES :
General injuries : . . 64] 29°0 | 34°6 | 25°7 | 28°37 | 28°38 | 16-12
Local injuries. i + + | 549] Stes | 48:0 | 40°9 | 37°14 | 55°79 | 29°04
Totals of all injuries . | 61°3 | 80-6 | 82:6 | 66:6] 65-st | 84-17 | 45°16
Totals of all diseases and injuries « | 541°0 | 679-6 | 780-0 | 639°8 | 630°80 | 765-80 | 435°93

THE R.A.F. MEDICAL SERVICES 547

Tape 7(c)
R.A.F. Diseases caused by Infection, Iraq, 1939-45
Incidence per 1,000 per annum
1939 | 1940 | 1041 | 1942 | 1943 1944 1945
DISEASES
Cli eal primary wae AS o's 3:6 | 20-4] 17°56] 24°93: 36°88
Bacillary primary . . . 4 20 3:0 art *4 go 47°09) 52°24
Amoebic primary | | ro} 4:0] a9 " 90 | 24°93 15
Recurrent . . . . - al = os o'72 = =
Totals. ry 2 24 65 75 | 61-1 52°08 96-96 95°27
Enteric grou
Typhoi 5 "9 _- o73 12 0°48 - _
Para (A. B. and C:) i os *s | 0-3 0-9 | 0-24 — 6-15
Clinical enteric . = = bed - 0°6 O72 ae _
Totals. . = 24 o's 06 27 144 Cas 6-15
Enteritis... | 84:8 | seo} 3-5 | 38-8 | aga] 22-16] g-aa
Malaria:
Clinical “ . | 18-5 go | 66 6-02 16-62 15°36
Quartan n ‘ - ord _- _ oz on i
Benign tertian’ . . . 14°6 22°0 21-7 25°26 40°47) 61s
Malignant tertian . + . 333 6°5 sit 16°00 30°75 oat
Recurrent ‘ te “Se 3 5's go 9°74 5°54] 3:07
Blanket treatment 3°07
Totals. - | 50:7] 43-0 | 38°5 | 38-6] 57-14 83-38) 27°96
Infective hepatitis (catarrhal
jaundice) : _ _ = 20°0 | 22°98 33°24) 12°29
pyrexia of uncertain origin 274 10 12 “7 3:28 24°93 73°75
lebotomus fever a 136°9 | 79°6 | 317°4 | 155°6 | 68-69 40°55) 85°32
Tofiuenza * =— _ 1's 16 1 3 2°77) “15
respiratory tract infections . | 103-3 | 67:1 | 83-3 | 106-4 | 105-86 | 146-82] 156-73
Upper revpirs all types i 24 33 2:9 20 3°13 ara? 6-76
easel diseases 1s-l 18-0 34°0 26°3 arei7z §2°63 39°95
Other infections 14°r 18°5 23°8 19°2 23°46 38-78) 36°88
All diseases caused by infection and
apres of uncertain origin 414°S | 291°7 | 564°0 | 477°1 | 366-65 544°32 526-43
All other diseases and unclassified
conditions . 206°§ | 213-6 | 229°6 | 361°2 | 367°50 508-31 487-71
Totals of all diseases. . | 621-0 | 505-3 | 793-6 | 838-3 | 734°15 | 1,052-63| 1014-14
INJURIES
General injuries. . : 97 22°3 go | 15-40 30°75 16-59
Local injuries 5 . | sor2 49°0 | 32°7 | 35°73 58°45 43°33
Totals of all inyuries . | 59°9 m3] 40-7 | sera 89-20} 59°92

Totals of all diseases and injuries . | 680-9 | 547°3 | 864-9 | 880-0 | 785-28 | 1,141°83| 1,074°06

548 CASUALTIES AND MEDICAL STATISTICS

TABLE 7(d)

R.A.F. Diseases Caused by Infection, West Africa, 1942-45
Incidence per 1,000 per annum

1942 1943 1044 1945
DISEASES
Dysentery:
Clinical primary . 2 1. Nae 28-5 10°68 1-21 1°95
Hacillary primary . ¥ . . . . 32°7 28-25 21-83 13°61
Amoebic primary . . . . . , 19°4 5°61 6°07 195
Recurrent ‘ . : . # 5 . o8 our = =
Totals. Bi-4 44°65 29°11 17°50
Paratyphoid ‘A. B. and C. ) o2 ao cont =
Clinical enteric . oz or - =
Totals. A o4 on —- _—
Enteritis. G . E : . 64:6 2°33 4°85 3°89
: : : : r : 338-4 161-46 94°60 48°62
Quartan : . : a a a = = =
Benign tertian f 5 2 A y 94 3°60 3 84 rare
Malignant tertian . . = 5 és 487° 219713 tigi 27°62
Recurrent. ; a : . + Bu 8-36 2°43 19s
Blanket treatment . ‘ . . . = = ae i,
Totals. 843°5 392-55 212°25 78-19
Infective hepatitis (catarrhal jaundice) . ay 34°49 8-40 =
Byrexia of uncertain origin . 7 mae 6: 7-30 2°42 1-95
Phlebotomus fever : = . . O90 or = ge
Influenza _ . . 38 O°53 as r-9s
Upper respiratory tract infections” . 75°t 75°02 89°75 44°74
‘Tuberculosis, all types : . . . 34 2°01 0-85 3°69
Venercal diseases . . 428 29 °By 448) 474
Other infections 23°70 17°56 15°89 9°92
All diseases caused by infection and pyrexia of
uncertain origin. . 1,1§0°2 $08 50 408-49 06 58
All other diseases and unclassified conditions | . 39372 300° 335°35 361 2
Totals of all diseases 1,543°4 907-10 743 °84 468-20
INJURIES
Ger ar-69 22°68 11°48
33°12 39°42 23°92
54°81 62-10 35°40
Totals of all diseases and injuries Q6r-or 805-94 $03°60

THE R.A.F. MEDICAL SERVICES 549

Injuries
In Tables 3(a), (b) and (c), injuries are analysed according to the
part of the body affected, no distinction being made between fatal and
non-fatal cases. The table below, which is extracted from the above-

mentioned tables, shows the number of injuries in the various ana-
tomical sites in descending order of frequency.

TABLE 8
R.A.F. Anatomical Sites of Injury

Percentage of
Anatomical Region Total Injuries All Injuries

Generalised, including missing, presumed dead . 105,131 419
Lower limb, excluding ankle and foot 3 i 40,217 16-0
Ankle and Foot : s : : 5 é 28,433 113
Head and Scalp . . 3 5 a 20,169 8-0
Arm, excluding hand and wrist ; . ef 16,8.44 6-7
Hand and Wrist. « é ‘ é : 13.739 5°5
Face and Mouth. 1 5 i : 9,248 3°7
Back and Vertebral Column. : ‘ : 4.906 2°0
Eyes and Eyelids. 2 < Fs : . 4,806 19
Chest and Neck , F ” i: 3 3,983 1°6
Buttocks and Pelvis 7 : 2 c z 1,983 08
Abdomen 7 f : 2 : i ‘ 1,172 o's
Ears - ‘ , : 2 i . * 325 on

Totals a ' 2 4 . : a 250,956 100°

Table 10 is a fuller analysis of injuries for 1944, the year in which there
was the greatest number of injuries, and Table 11 shows aircrew
injuries for the same year.

Although these statistics apply to both aircrew and ground personnel,
the dominating problem in the R.A.F. is the care of aircrew. These
carefully selected and highly trained young men were fighting either
alone, as in the case of fighter pilots, or in small units of a few men.
They lived and worked in exceptional circumstances; they were sub-
mitted to the special risks of flying at high speeds, to the hazards of
weather, altitude and cold, and to the perils of exposure to enemy action.
Ground personnel were exposed to a much lesser degree to risks attri-
butable to war.

FATAL INJURIES

In certain circumstances loss of life results from a multiplicity of
injuries. In no other Service, and in no other conditions, was this such
a common event—mid-air collisions, diving into the ground at high
speed, fierce and rapid fires in aircraft. Such accidents result in injuries
which allow of no survival.

550 CASUALTIES AND MEDICAL STATISTICS

Analysis of these cases of fatal injury shows that they fall into three
main groups. The first results in a pulverisation of the whole body
where the force of impact on crashing or the severity of an explosion
causes complete disintegration of the whole body. The second and more
common group results in multiple injuries with fractures; most of the
bones in the body may be fractured and the skull splintered into small
fragments. Associated visceral injuries are severe and extensive and
death is usually instantaneous. The third group of cases comprises
severe burns which result in incineration of the body.

COMMON NON-FATAL INJURIES

Certain characteristic injuries were found to occur in flying personnel.
Burns, frostbite, immersion injuries, head injuries and certain types of
fracture all presented problems to R.A.F. surgeons.

BURNS

Burns (Table g) were responsible for an important number of injuries
to R.A.F. flying personnel. There was often a characteristic distribution
of burns in those who survived, particularly in fighter pilots, involving
the face, hands and wrists. The area affected was small and the associated
mortality slight but the morbidity from these burns was very great.
It was found that protection by gloves, helmets and clothing was of the
greatest value and the wearing of gloves and helmets did, in fact, give
complete protection in many instances. It will be noted that there was
a higher percentage of burns of the leg in men serving abroad and an

TABLE 9
R.A.F. Burns, 1939-45

Total Force Home Abroad
Site of Burn Percen- Percen-
No. of | tage of | No. of No. of | tage of
Cases Total | Cases Cases ‘otal
Generalised " d 2,526 20°8 1,154 1,372 26-4
pace and Hands, é 1,170 9°6 867 303 5°8
Foon Eine : 1,560 12°8 1,123 437 8-4
Hand and Wrist. - 1,918 15°83 1,425 493 o°5
Am ‘ : ke 922 7°6 519 403 7
Foot and Ankle . . 1,871 15°4 | 1,090 781 15-0
Bw . ‘f : : 1,852 15°3 651 1,201 23¢1
Trunk. : a 327 2°7 114 213 4rr
Totals 2 . | 12,146 100'0 | 6,943 5,203 100°
Percentage of Total
Injuries . «| 48% 3°8% 75%

THE R.A.F. MEDICAL SERVICES 551

important factor in this was the habit of working and flying in shorts.
Obviously, under prevailing conditions, it was impossible to wear many
clothes, but the small loss of comfort in wearing gloves, long sleeves
and long trousers often meant the difference between a minor and a
severe burn.

Shortly after the outbreak of the war it was realised that improved
forms of treatment for burns were required in the R.A.F. At this time
the treatment of burns consisted mainly of the use of coagulants,
chiefly tannic acid. A Burns Sub-Committee was set up and in 1941
four Burns Centres were formed at the R.A.F. Hospitals at Halton, Ely,
Cosford and Rauceby. The primary object of these centres was to
establish uniform and recognised treatment of burns in the R.A.F.
These specialised R.A.F. Centres made considerable contributions to
the advances in the knowledge of the treatment of burns. (See R.A.F.
Medical Services Vol. I, p. 302.)

HEAD INJURIES

Aircraft crashes result in a large number of severe head injuries.
A study of head injuries in aircrews in the first two years of the war
was made in 1942 (Stanford Cade, Brit. J. of Surgery, 1944, 32, 125).
The report dealt with a period of 25 months, September 3, 1939 to
September 30, 1941, and consisted of an analysis of 1,545 cases in which
the predominant injury was to the cranium. The number of head injuries
over this period was only slightly less than the number of multiple
injuries; it is apparent that head injuries were a very important cause
of loss of trained flying personnel. The conclusions drawn from this
investigation were:

(1) The vast majority of fractures of the skull were fatal. The fatality
rate was 99-4 per cent. for cases of fractured skull associated with other
injuries and 93-7 per cent. for cases of fractured skull only. Of the
56 cases of fracture of the skull who survived, the majority were simple
fractures of the vault. The majority of fatal cases had fractures of both
the vault and the base of the skull.

(2) Death was instantaneous in 83 per cent. of the fatal cases;
13 per cent. died within the first twenty-four hours so that of the
fatal cases only 4 per cent. lived more than one day.

(3) All cases of concussion survived.

(4) The end result of head injuries in aircraft accidents can be
expressed by the ‘all or nothing’ principle. If a case of head injury
escapes death, the injury is such that return to full flying duties can be
confidently anticipated; 74 per cent. of survivors returned to full
flying duties.

552 CASUALTIES AND MEDICAL STATISTICS

(5) Crash landing on return from operational flights accounted for
44 per cent. of the total of cases.

(6) There were very few fatal cases due to missile wounds of the
head. Of those who returned, there are only 18 cases recorded in the
entire R.A.F. for the first 25 months of the war.

MAXILLO-FACIAL INJURIES (See Inter Allied Conferences on War
Medicine, Sqn.-Ldr. T. Cradock Henry)

The typical deceleration injury in aircrew is fracture of the middle
third of the face. Three types commonly occur.

(1) The malar-maxillary fracture which may result in loss of malar
floor, enophthalmos and by direct injury to one of the muscles may
cause permanent diplopia.

(2) The naso-maxillary fracture in which displacement or crumpling
of the septum will obstruct the airway—a matter of great significance
in flying.

(3) Fracture of the tooth-bearing segments with resultant mal-
occlusion,

The mandible is rarely fractured in comparison with the middle
third of the face; of 487 injuries of the middle third and the mandible,
only 34 were fractures of the mandible. Where fracture of the mandible
has been recorded comminution has usually been severe.

As injuries to the face were usually due to flying accidents and not to
missile wounds they did not as a rule present large tissue losses and the
associated problems of these rarely arose.

The combination of burns with other maxillo-facial injuries neces-
sitated special provision for treatment and accommodation. Each
maxillo-facial unit was self-contained at a base hospital and under
unified control.

SPINAL INJURIES

Spinal injuries were common as a result of aircraft crashes. Two main
causes of fracture of the spine are recognised.

(1) Vertical compression. A fall in the standing or sitting position
may cause telescopic compression and simple crush fracture of the
vertebrae, usually in the lumbar region. This is the commonest cause
of spinal fracture in civil life and is a common injury in heavy parachute
landings.*

(2) Forcible flexion. Violent bending movements which double up
the spine like a clasp knife cause a more severe fracture, again in the
lumbar region because this is the site of greatest bending movement.

* See R.A.F. Medical Services Vol. II, pp. 478, 483-84.

THE R.A.F. MEDICAL SERVICES 553

Both types of fracture may occur in aircrew. When an aircraft makes
a crash landing, the pilot may strike the ground violently in a sitting
position and sustain a simple vertical compression fracture of the first
type. There is no efficient form of protection against this injury.
More frequently, however, the pilot’s feet, hips and lower spine are
relatively fixed, the upper spine and head travel forward with consider-
able momentum and a forcible flexion fracture of the second type is

y AIR ACCIDENTS

A B Cc

Diagrammatic representation of Crash Fractures
of Spine.

A—Compression fracture as may occur on heavy
landing by parachute.

B—Dorso-lumbar flexion fracture of spine in air-
craft when wearing lap-type safety belt.

C—Cervico-dorsal flexion fracture of spine when
wearing shoulder-type safety harness during
an aircraft cvash.

554 CASUALTIES AND MEDICAL STATISTICS

sustained. If this forward movement is unrestricted the fracture is
likely to be of a severe type occurring in the lumbar region and often
with a crushing of the nerves and paralysis. A much more severe type
of fracture was usual in bomber crews, where certain crew members,
owing to the nature of their duties, wore less effective restrictive
harness. The harness,* however, although undoubtedly responsible for
preventing a number of fractures of the spine, may also be held respon-
sible for causing some fractures of the upper dorsal vertebrae—since
the trunk is held it cannot double up at the waist and as only the head
travels forward with momentum the level of the fracture is raised.
(See diagram on previous page.)

OTHER ORTHOPAEDIC INJURIES

A fairly large number of fractures due to air crashes and road accidents
has always been a feature of R.A.F. surgery. A special orthopaedic
service was instituted during the war to deal with the large numbers of
severe orthopaedic injuries which could be expected from intensive
air warfare.

Certain injuries were more common than in other Services. Multiple
fractures were common; three or more distinct injuries were often
found in the same person. Fractures of the talus with associated ankle
joint injuries were seen particularly in pilots; they were caused by the
mid-tarsal region of the foot being driven forcibly downwards on to the
rudder bar.

FROSTBITE

The danger of frostbite was constantly present for R.A.F. bomber
crews operating over Germany, where for most of the year extremely
low temperatures were met. Flying at altitudes between 20,000 and
25,000 feet the external air temperature varied between — 30°C and
—55°C. Means of protection against cold and frostbite had to be
devised by the development of suitable clothing, including electrically
heated flying suits, waistcoats, gloves and boots. It was necessary to
find out where applied heat would be most effective, either periph-
erally or centrally to limbs or body, particularly over the course of blood
vessels. The main lessons learned were that crew discipline regarding
clothing and adequate oxygen intake is a potent factor in preventing frost-
bite and that for this purpose reliance should not be placed on cabin
heating for war planes, particularly as they may be holed in combat. (See
R.A.F. Medical Services Vol. 1, p. 109 ff.)

It is of interest to note that during 1944-45 frostbite only occurred
at a rate of -08 per 1,000 individuals engaged in bomber sorties.

* See R.A.F. Medical Services Vol. U1, Chap. 10, pp. §20, 521.

THE R.A.F. MEDICAL SERVICES 555

IMMERSION INJURIES

These injuries occurred in aircrew who were forced to spend long
periods in rubber dinghies after crashes at sea. A full account of these
conditions is given in Medicine and Pathology in this series.

INJURIES, 1944

A more detailed analysis of injuries is presented for 1944, the year
which had the highest injury rate. Table 10 gives the injuries for the
total force in 1944 and shows the number of cases (including those
remaining from 1943), the number of deaths, the number finally in-
valided or returned to duty, the number remaining in hospital on
December 31, 1944, the incidence of cases per 1,000 of strength, the
average number of sick daily and the average number of days treatment
before return to duty. Table 11 is an analysis of injuries among all
personnel with aircrew qualifications in 1944; the majority of these
injuries were sustained in flying accidents or through enemy action
but some were due to other causes and there were men with aircrew
qualifications who rarely flew but whose duties were purely adminis-
trative. Of the 491 cases of internal derangement of the knee recorded
it is fair to suppose that the majority were athletic injuries unconnected
with flying.

General injuries in the whole force were responsible for 31,257 cases
or 44°3 per cent. of the total injuries and 18,349 or 971 per cent. of
the total deaths from injuries. Those listed as missing, presumed dead
accounted for 13,015 cases and of these 10,868 were aircrew. As would
be expected both the categories Multiple Injuries with Fractures and
Multiple Injuries with Burns show high fatality rates—71-2 per cent.
and 82:3 per cent. for the total force and 87-4 per cent. and 88-6 per
cent. for aircrew. Cases of Fractured Skull with other Fractures had
a fatality rate of 79-8 per cent. for the total force and 100 per cent.
among aircrew.

The figure of 128 cases of general injuries finally invalided cannot be
regarded as a true picture since a number of the more severe cases were
still in R.A.F. hospitals at the end of the year and were eventually
invalided, while a number of those invalided during 1944 had been
injured in the previous year. But even taking these factors into con-
sideration a remarkably high proportion (39-0 per cent.) of cases were
able to return to duty.

556 CASUALTIES AND MEDICAL STATISTICS

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562 CASUALTIES AND MEDICAL STATISTICS

TABLE 11
Aircrew Injuries, 1944—G.D. Officers and Airman Aircrew

Number of Cases Number
Returned to Duty | Number Finally
CAUSE OF DISABILITY or Remaining in of Invalided | Totals
Hospital at end Deaths | During
of Year Year
GENERAL INJURIES
Multiple Injuries and Fractures “ . 390 2,953 3s 3,378
Multiple Injuries and Burns. . . 190 1,535 8 1,733
Multiple Wounds _ ° - 60 - 6
Fractured Skull with other fractures u A 5i = sé
Missile wounds, multiple és 5 . 40 13 2 ss
Minor Injuries i f 3 ‘ A 250 = a 250
Generalised Burns B + a 240 88 7 33
Burns of face and hands. . 5° mi 8 5)
Frostbite in Aircrew during Flight® | . 40 CS 2 42
Eaposure to natural elements. ‘ 20 13 1 34
Drowning, including effects of Immersion - 10 gI rae 101
Injuries to ‘Tissues and Specialised
Structures® . . 770 - - 770
Chemical agents, effects of contact with® | - + _ 2
Other Injuries ae os S 820 22 - B42
Missing, Presumed dead © 7 5 == 10,868 ors 10,868
Totals. i Se Ae es 2,880 15,648 63 18,59
LOCALISED INJURIES
Cranium:
Contusions and Wounds . x . . 410 34 s 449
Fractures of Skull, Vault . 2 e : 50 44 2 6
Fractures of Skull, Base. . * * ee 89 s 89
Concussion = ‘ c ie 450 1 1 452
Missile wounds 2 : 4 i: ae 31 2 33
Totals i 4 i S 4 910 199 10 1119
Face and Mouth:
Contusions and Wounds E ‘ 260 - - 260
tures and Fracture dislocations 120 = t iat
Missile wounds x : : : 10 - - 10
Tooth Injuries : . - ¥ . 10 coat —_ 10
Burns and Scalds_. - * a 60 = t 61
Totals. ‘ Pade ; 460 = 2 462
AS 40 - — 40
Eye Substance—Superticial wounds | : 50 — = 50
Fye Substance—Injury to Eyeball | z 110 = I int
Eye Substance—Removal of eye ‘ 30 _ — 30
Missile wounds . . . . . ae at 1 1
Burns and Scalds_ . . . 5 . 10 _- _- 10
Totals . ri * ~ ri 240 oe 2 242
Ears:
Pinna, injuries to . . . 10 a 10
Rupture of Tympanic membrane |: 40 — 40
Totals. mor eee MS : so - _- 50
Neck:
Contusions and Wounds . . . 10 I ‘aca um
Missile wounds . . . . . _ 2 _- 2
Burns and Scalds_ . . . . . 10 a: ao 10
Totals . . . . 20 3 = 23

® See p. 483.

THE R.A.F. MEDICAL SERVICES 563

TABLE 11 (contd.)
Aircrew Injuries, 1944—G.D. Officers and Airman Aircrew

Number of Cases Number
Returned to Duty | Number Finally
CAUSE OF DISABILITY or Remaining in of Invalided | Totals
Hospital at end Deaths During
of Year Year
Chest:
Contusions and Wounds . . . . 20 1 = 2
Penetrating wounds : : = 5 = 2 2
Fractures - . . . . 60 t Car or
Missile wounds i. : z 30 16 1 47
Burns and Scalds . . . a fi 10 = om 10
Totals . : . + * 120 20 t 141
Back and Vertebral Column: .
Contusions and Wounds . . . 7 130 _ = 130
Fractures . * 2 > "3 130 16 9 155
Fracture of Coccyx” . * FA =, 40 = 1 4t
Missile wounds . . . = 3 _- v ae 1
Totals . . . 3 . 300 17 10 327
Abdomen:
Contusions and Wounds . . e . 20 2 1 23
Wounds involving viscera . . . 10 oe 1
Missile wounds . . . . ~ 10 3 = u
Totals . . m ‘p A 4° 13 1 54
Buttocks and Pelvis:
Contusions and Wounds . . . * 10 - a 10
Wounds of Generative Organs rae 10 3 —_ 10
Fractures . . . o : 20 = = 20
Missile wounds . i‘ . . . 10 mae 1 uw
Burns and Scalds_ . . . . . 10 alt = 10
Totals . . . . zi 60 om 1 61
Copper Limb—hands and wrists:
Contusions and Wounds . . . t; 140 — 140
Fractures - . . + . 5 190 i 1 191
Missile wounds . . . 4 s 30 1 - 31
Burns and Scalds : 2 < ‘ 40 a — 40
Totals * - . ‘ é 400 1 (3 402
Upper Limb—rest of limb:
Contusions and wounds . . . . 100 = - 100
Sprains and Strains 2 « = ‘. 30 _ - jo.
Fractures i : . 3 : F 760 = 5 705
Missile wounds . . . . * 60 1 4 65
Totals . a . : 950 1 9 960
Lower Limb—foot and ankle:
Contusions and Wounds .
Sprains and Strains i :
Fractures . S . . .
Missile wounds ‘ . he .
Burns and Scalds
Totals . . * . .

Lower Limb—rest of limb:
Contusions and Wounds.
Sprains and Strains 2
Fractures. ee
ED:KEce 25 edtites dies
Missile wounds ORs
Missile wounds, Multiple’

Burns and Scalds

Totals

Total Injuries

Amputations . €
Effects of Heat .
Late complications of trauma

GRAND TOTALS. x P é

1QCMS

564 CASUALTIES AND MEDICAL STATISTICS

FATALITY RATES FOR CASES OF SKULL INJURY, 1944

Skull injuries were the most important cause of death among localised
injuries.

Fatality Rates per cent.
NATURE OF INJURY

| Total Force Aircrew
Contusions and Wounds . 4°6 76
Fractures of Skull:
Vault 5 2 a 25°1 45°8
Base . A 7 Fi 51°8 98-9
Concussion . E : 0°07 o-2
Missile Wounds. 7 65-0 100°0

A comparison of the figures for fractured skull for the total force
over the period 1939-45 (Table 3(a)) reveals one of the difficulties of
statistical classification. It might be supposed that the number of cases
of fractured skull would bear some direct relationship to the total
number of injuries. Thus, it is natural to expect that in 1944, when there
was a total of 68,360 injuries, there would be more cases of fractured
skull than in 1941 when there were 32,638 injuries. This is indeed borne
out in the figures for fractured skull without other injuries as shown
below; but there were many more cases of fractured skull with other
injuries in 1941 than in 1944.

Fractured Skull with other

fractures Fractured Skull
Year
No. of Cases* Deaths No. of Cases* Deaths

1939 140 122 101 59
1940 382 360 298 196
1941 640 516 419 280
1942 463 405 497 314
1943 232 205 462° 247
1944 104 83 633 248
1945 85 61 424 174

* Fresh cases and cases remaining from previous year.

In fact the differences are largely due to varying nomenclature which
makes exact comparison impossible—for example, in 1944 many cases
of fractured skull with other fractures were classified under the heading
Multiple Injuries with Fractures; these cases cannot now be identified.

FACE AND MOUTH

In the investigation of head injuries in aircrew carried out for the
first two years of the war there were 162 maxillo-facial injuries out of

THE R.A.F. MEDICAL SERVICES 565

a total of 545 cases. None of the maxillo-facial injuries was fatal.
With the exception of fractures of the lower jaw, maxillo-facial injuries
recover very quickly; thus most fractures of the nose returned to duty
within a few days.

EYE INJURIES

Eye injuries were an important cause of morbidity. The average
period of treatment was 17 days and for injuries resulting in removal of
the eye the average period of treatment before return to duty was 88
days.

566 CASUALTIES AND MEDICAL STATISTICS

INJURIES—CAUSES

Table 12 is an analysis of injuries according to the more common
causes and shows the number of fatal and non-fatal cases from each
cause for the war years. The anatomical distribution of injuries from the
various causes is also shown but this does not differentiate between fatal
and non-fatal cases.

Little comment is necessary on injuries due to ENEMY AIR ACTION.
All missing persons presumed to be dead are included in this group.
This column reflects the rising scale of operations against the enemy and
the tremendous cost in human life involved. The peak casualty figures
due to enemy air action were in 1943 when 12,179 were killed and in
1944 when 13,928 were killed.

The casualties from ENEMY GROUND ACTION show a steady rise in
numbers up to 1944. This can be correlated with the steadily increasing
size of the force abroad exposed to enemy ground activities and the
development of close fighter-bomber support for the Army with the
necessity of establishing airfields as near to the front line as possible.

As would be expected, AIR-RAID casualties were greatest in the years
1940 and 1941 when the enemy was still in a position to carry out heavy
bombing attacks on this country.

FLYING ACCIDENTS took a heavy toll of life and the number of fatalities
from this cause was nearly half the number of fatalities from enemy air
action. There must, inevitably, have been some confusion in the
classification of accidents as due to enemy air action or flying accidents;
accidents which occurred on take-off or landing on operational flights
were sometimes recorded as flying accidents and sometimes as due to
enemy air action.

PROPELLER ACCIDENTS caused a relatively small but avoidable series
of accidents. The increased amount of flying as the R.A.F. expanded,
which is reflected in the increased flying accident figures over the
years 1941-44, would have been expected to cause a commensurate rise
in propeller accidents. In point of fact, the number of propeller accidents
varied only slightly over the years 1941-43 and this may be attributed
to stricter precautions against such accidents.

Injuries in the column headed MECHANICAL TRANSPORT represents
injuries suffered both by occupants of various vehicles involved in
accidents and by pedestrians. It includes a large number of people who
were injuried in off-duty hours. In 1944, for instance, of the 5,221
casualties due to mechanical transport accidents 1,362, of which 56
were fatal, occurred off-duty.

ATHLETIC INJURIES provided the greatest single cause of non-fatal
injuries and over half of these were injuries to the lower limb. The

THE R.A.F. MEDICAL SERVICES 567

seemingly large number of deaths from athletic injuries is due to the
inclusion of deaths from drowning while bathing. In 1943 there were 49
deaths from athletic injuries, of which 45 were due to drowning, one to
a fractured cervical spine from diving and three to football injuries.

568 CASUALTIES AND MEDICAL STATISTICS

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THE R.A.F. MEDICAL SERVICES 569

The Strength of the Royal Air Force by Age Groups, 1939-45

The figures given in Table 13 are derived from returns provided by
the Manning Branch of the Air Ministry, which give the numbers of
men for different age groups at January 1 and July 1 each year. The
figures shown for each year have been calculated by adding the strengths
on January 1 and July 1 of the year and January 1 of the following year
and dividing by three. It should be noted that the figures obtained may
mislead if the force either increased or decreased in a particular year
as the R.A.F. did in 1939. Returns for shorter intervals (months, for
example) would be required to give a more accurate assessment of the
average yearly strengths, but the returns at intervals of six months are
the only ones available. For the first two years, 1939 and 1940, the totals
for all R.A.F. personnel are known but the frequencies for age groups
are available only for airmen. The relative frequencies for different age
groups for airmen must have been close to those for the total force.

The changing constitution of a force is the result of a number of
factors—the intake of recruits, the loss of men falling out for various
reasons and ageing of personnel in the Service.

The main changes from 1939-43 must have depended on the influx
of recruits and in 1945 on the outflow of demobilised men. Under the
1939 Military Training Act 16,000 men aged 20 expressed preference for
service in the R.A.F. and they were called up in October and November
of that year. However, the reservists recalled outnumbered the younger
recruits.

The National Service Act of 1939 made all men between the ages of 18
and 41 liable for service in the Armed Forces and the first registration
under this Act was on October 21, 1939. In 1940 age groups 20 to 35
were registered and in the first six months of 1941 registration was
extended up to the age of 40. In 1941 the lower age of registration was
reduced to 19 and in 1942 to 18. The National Service Act of 1941
extended the liability for service up to the age of 51 but men over the
age of 40 were never, in fact, called upon to register. During 1940 and
until April 1941 many younger men were in reserved civilian occupations
but from that date they were combed out and the policy thereafter was to
grant few reservations to fit men below the age of 35. The ages of
reservation for various occupations were gradually raised throughout
1942. These circumstances are reflected in the age distribution for the
years 1939-42. In 1941 the R.A.F. was beginning to show signs of
‘ageing’ but the balance was largely restored by 1942 as the younger men
previously reserved were called up.

In 1943 and 1944 deferment of service was more and more restricted,
being cancelled in stages, and the closest approach to total mobilisation

570 CASUALTIES AND MEDICAL STATISTICS

of fit men up to the age of 40 was reached at the end of 1944. Coal
miners, agricultural workers and some others were still reserved. The
proportion of men between the ages of 20 and 24 remained practically
constant from 1942-44 but the average age of the force was still increas-
ing. The maximum size of the force had now been reached and the
trend must have been due principally to the ageing of men in the Service.

Tf full mobilisation had been required throughout 1945 it would have
been expected that the average age of the force would be about one year
higher than in 1944. Actually the average age for 1945 was only 0-07
years greater than that for 1944. This was due, of course, to the begin-
ning of demobilisation leading to a relatively greater reduction in the
older age groups. Changes in the maximum age of men called up was
another factor; the maximum age was reduced to 35 on October 1, 1944,
and to 30 on May 1, 1945.

571

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THE R.A.F. MEDICAL SERVICES

19*CMS

572, CASUALTIES AND MEDICAL STATISTICS

DISEASE AND INJURY ANALYSED BY AGE GROUPS

Tables 14(a) and 14 (b)show sickness of over 48 hours’ duration as rates
per 1,000 of strength per annum for each age group; important individual
diseases, disease groups and injuries are shown separately.

For the first two years (1939 and 1940) the incidence of sickness by
age groups is available for airmen only. From 1941 data are available for
officers as well as airmen.

As would be expected, the highest incidence of disease was in the
under 20 age group. The problems caused by herding together young
recruits, the vast majority of whom are new to communal life, are well
known. The exertion and fatigue of the unaccustomed life, the rigours
of service conditions compared with home life and the overcrowding in
almost every phase of their activities all played their part in producing
this high incidence. Sickness rates tend to be much higher among
young recruits to the Services than in comparable groups of young'men
in schools and colleges where conditions would also tend to favour the
spread of infections; the important factor in this difference between
recruit camps and schools appears to be the more rapid change over in
the personnel of the former,* where, as soon as one community has
become adapted to its bacteriological environment, another group of
non-immunes is introduced.

There is a considerable drop in the incidence of all disabilities in the
20-24 age group but this group does show a consistently higher sickness
rate than the older age groups. There is little difference in the sickness
rates for all age groups between 25 and 44, but a rise in incidence occurs
in the over 45 age group which, under war-time conditions, contained
many men over 60.

UPPER RESPIRATORY TRACT infections provided a true reflection of the
susceptibility of recruits and the incidence was much higher in this
category throughout the war years. In 1944 the rate in the under 20 age
group reached the very high level of 448 cases per 1,000 of strength
whereas the incidence in the other age groups was no higher than the
average for the other war years. In the December quarter of 1943 there
was an epidemic of influenza in the civilian population; the full force
of this epidemic was not felt in the recruit centres until the early months
of 1944 and this would account for the high incidence of upper respiratory
tract infections for this year.

PNEUMONIA showed its highest incidence in the under 20 age group;
this is in keeping with the higher rate of upper respiratory tract infec-
tions in this group. The incidence in the over 45 age group is consis-
tently slightly greater than in the age groups 20-44. In 1944 all age
groups showed an increased incidence of pneumonia but this was most

® R.A.F. Medical Services Vol. II, p. 577.

THE R.A.F. MEDICAL SERVICES 573

apparent in the under 20 age group where the incidence rose to 42 per
1,000 of strength compared with 13 per 1,000 in the previous year.
The incidence in the over 45 age group was 12 per 1,000 compared with
7 per 1,000 in the previous year. Most cases occurred in March and
April following the season of upper respiratory tract infections. There
was no increase in notifications of, or deaths from, pneumonia in the
civilian population in 1944.

The highest incidence of PULMONARY TUBERCULOSIS was in the under
20 age group and reached a peak of 10 cases per 1,000 in 1944 and 1945
when the average incidence for the whole force was 2:1 per 1,000 in 1944
and 2-4 per 1,000 in 1945. The explanation must lie partly in the greater
use made of mass radiography in R.A.F. recruit centres in the later
years of the war; this revealed many cases of unsuspected tuberculosis
which swelled the notification figures in that group. (See R.A.F.
Medical Services Vol. 1, p. 288.) There was no significant difference in
the incidence of tuberculosis in the age groups other than that of the
under 20.

TUBERCULOSIS IN OTHER SITES also showed a predilection for the under
20 age group and reached a peak incidence of 4 per 1,000 in 1945.
There was a steady fall in incidence with increasing age and the lowest
incidence was in the 40-44 age group.

VENEREAL DISEASE was most prevalent in the age group 20-24. All age
groups showed a tendency to increased incidence as the war progressed.
It is not surprising to find the maximum incidence in the 20-24 group;
the majority were unmarried and for many it was the first experience of
being away from the moral ties and influence of home life. There would
still be an element of bravado in their lives and many would be over-
indulging in drinking for the first time.

The table for INFECTIVE HEPATITIS shows that the young are much
more susceptible than the old and this bears out the experience of the
Army. The peak incidence was in 1943 and 1944, corresponding with
the major epidemics in the Middle East.

POST INOCULATION EFFECTS showed a heavy incidence in the under 20
age group. There is a considerable fall in incidence in the 20-24 age
group and then, on the whole, a very slight decrease with increasing
age. An attempt was made to provide every recruit with vaccination
against smallpox and inoculation against the enteric fevers. This meant
that nearly every man in the under 20 age group experienced inoculation
against the typhoid group for the first time in his life and many were
vaccinated for the first time. In the older age groups, although the aim
was to maintain a man’s immunity, a much smaller proportion were
inoculated and vaccinated each year. Booster doses of T.A.B.C. and
revaccination seldom produced as severe a reaction as the initial
doses.

574 CASUALTIES AND MEDICAL STATISTICS

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576 CASUALTIES AND MEDICAL STATISTICS

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Other Infections

Septic Conditions

Alimentary System
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Enteritis

TABLE 14(a)—{(contd.)

R.A.F. Incidence of Sickness and Injury Analysed by Age Groups, 1939-45

578 CASUALTIES AND MEDICAL STATISTICS

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Locomotor System

Rheumatic Group of Diseases

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Psychoneurosis .

TABLE 14(a)—(contd.)

580 CASUALTIES AND MEDICAL STATISTICS

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THE R.A.F. MEDICAL SERVICES 581

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Eye
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582 CASUALTIES AND MEDICAL STATISTICS

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584 CASUALTIES AND MEDICAL STATISTICS

There is an interesting contrast between the age distributions of
AMOEBIC and BACILLARY DYSENTERIES; amoebic dysentery shows its
greatest incidence in the middle age groups and its least at the extremes.
whereas bacillary dysentery has its highest incidence in the under 20
age group and steadily and progressively decreases with increasing age.
Amoebic dysentery is almost entirely confined to tropical countries and
as a smaller percentage of men under 20 and men over 45 were sent
abroad than men in the middle age groups the higher incidence in the
latter is not unexpected. Similarly, although bacillary dysentery occurs
in all climates its greater prevalence in local populations abroad and the
poor hygienic conditions existing abroad, would also lead one to expect
a higher incidence in the middle age groups. An attack of bacillary
dysentery does not confer immunity to further attacks. Following an
attack, there is an increase in specific antibodies in the blood but,
unlike the enteric fevers, the site of infection is local in the intestinal
mucosa and antibodies can play little part in preventing infection.
Only in B. Shiga infections do antibodies play any part in reducing the
severity of the disease. It is probable that the explanation of the decreas-
ing incidence with age lies in the improved hygienic standards which
normally accompany experience of life abroad. Amoebic dysentery, on
the other hand, shows a tendency to relapse and many cases recorded
in the older age groups must represent recurrences.

MALARIA shows its greatest incidence in the 20-24 age group with a
progressive decrease in incidence with age. The lower incidence in the
under 20 age group is because relatively fewer of this group were sent
abroad. Immunity in malaria, unlike bacterial infections, is dependent
on the continued presence of the malaria parasite in the body. This type
of immunity is called premunition; once the parasites have left the body
premunition gradually disappears. The immunity is specific for homo-
logous strains and fresh infection can occur with heterologous strains.
Increasing experience of tropical conditions and of the value of pro-
phylactic measures would also be factors in the decreasing incidence
with age.

The incidence of ENTERIC FEVER remained at a very low level in all age
groups and in only one instance did the rate rise above 1 per 1,000 of
strength—in 1942 in the under 20 age group when the incidence was
1-2 per 1,000.

ENTERITIS showed a high incidence in all age groups in the early
years of the war but fell considerably from 1943 onwards. There is a
general tendency to increased incidence in the younger age groups.

The miscellaneous group OTHER INFECTIONS follows the general trend
in showing the highest incidence in the under 20 age group and then
decreasing incidence with age. This applies also to the group of SEPTIC
INFECTIONS.

THE R.A.F. MEDICAL SERVICES 585

The usual history of PEPTIC ULCER was not belied by the experience
of the R.A.F. and there was a steadily increasing incidence with age.
It must be remembered, however, that peptic ulcers are very rarely
cured and as no distinction is made between fresh cases and recurrent
cases, the older age groups would tend to show a far greater proportion
of recurrent cases than the younger age groups. In other words, the
figures for the different age groups do not represent the absolute
incidence of new cases of peptic ulcer in any one year but are made up
of new and recurrent cases. (See also under ‘Sickness as a Whole’,
p- 526.)

The heading OTHER CONDITIONS OF THE ALIMENTARY TRACT covers a
vast number of different diseases and includes such common conditions
as appendicitis and hernia. There is a high incidence in the under 20 age
group but the other groups show a fairly constant rate.

The lowest incidence of CIRCULATORY SYSTEM DISORDERS is in the
age group 20-24. The higher incidence in the age group under 20 is
possibly due largely to two factors:

(a) A not inconsiderable number of men with organic disease of the
heart may have been passed fit by the National Service Medical
Boards and their disability not discovered until later when they
developed symptoms or on routine medical examination by R.A.F.
medical officers.

(b) The after-effects of rheumatic fever. Rheumatic fever is primarily
a disease of recruits, apprentices and boy entrants.

After the age of 30 there was a rapid increase in the incidence of
circulatory system disorders with increasing age.

PLEURISY WITH EFFUSION is classified with no reference to aetiology.
It is probable that most of the cases with no evident underlying path-
ology at the time were, in fact, due to pulmonary tuberculosis. The
highest incidence is in the under 20 age group.

OTHER CONDITIONS OF THE RESPIRATORY TRACT have their highest
incidence in the under 20 age group and in the over 45 group. These
two groups represent the chief sufferers from acute respiratory condi-
tions in the first instance and chronic conditions in the second.

Apart from a slightly higher incidence in the under 20 age group
DISEASES OF ALLERGY show no special predilection for any particular age
group.

The groups of diseases of the URINARY SYSTEM and the GENERATIVE
SYSTEM contain a large number of common conditions and there is little
to be gained by attempting to relate them to age, for there are no
considerable differences between the age groups.

The RHEUMATIC GROUP OF DISEASES are all conditions which, in
common experience, are more prevalent in the older age groups and this

586 CASUALTIES AND MEDICAL STATISTICS

is borne out by the R.A.F. figures. These remarks apply also to the
LOCOMOTOR SYSTEM conditions.

War-time conditions provided a fruitful breeding ground for the
PSYCHONEUROSES. Incidence was highest in 1943 and 1944 and there is an
increasing incidence with age. This may be correlated with the increas-
ing stress and strain associated with the greater responsibility of higher
rank and with the added worries of home and family.

Cases of PSYCHOSES AND PSYCHOPATHIC PERSONALITY showed no
increase in incidence with age. In the development of psychoses a man’s
predisposition and past history are more important than psychological
factors such as harrowing emotional experiences or heavy responsibilities.

The higher incidences of MENTAL DEFECTS and EPILEPSY in the under
20 age group probably represent the unavoidable number of such men
who, withholding any history, are passed as fit by the entry medical
boards and are detected soon after enrolment.

Organic NERVOUS DISEASES show their highest incidence in the over
45 age group and there is a progressive increase in incidence with age.

EAR, NOSE AND THROAT conditions show a decreasing incidence with
increasing age. In common with other infections, there is a markedly
higher incidence in the under 20 age group. Here again, large numbers
of recruits were found to be suffering from chronic ear conditions which
had not been commented on by the National Service Medical Boards.

SKIN CONDITIONS follow the trend of infections in general and show a
decreasing incidence with age.

INJURIES were most common in the under 20 age group and there is
a progressive decrease with age.

THE R.A.F. MEDICAL SERVICES 587

Incidence of Sickness and Injury among Officers,
Airman Aircrew and Ground Personnel, 1939-45

Tables 15(a) and 15(b) record the incidence of sickness and injury
among General Duties officers, non-flying officers, airman aircrew and
airman ground personnel. For the years 1939 to 1941 disease and injury
among airmen were analysed by trade groups and these years are shown
in Table 15(a). The practice of separating the trade groups ceased in
1941 and from then on the only distinction was between airman aircrew
and airman ground personnel (Table 15(b)).

The General Duties (G.D.) branch of officers includes all those
officers with aircrew qualifications. The majority of officers in this
branch were engaged in active flying duties during the war but there
were G.D. officers whose duties were mainly administrative. Among
airman aircrew, a smaller proportion were confined to ground duties.

These tables are not reliable for a comparison of sickness rates in the
various groups as they cannot be standardised for age. Many of the
apparent differences are due to differences in the age structures of the
groups.

The stress of flying, the long hours involved, the physical hardship
and the extremes of heat and cold make it not surprising that there was a
higher sickness rate among flying personnel than among ground
personnel. This is particularly evident in the incidence of UPPER
RESPIRATORY TRACT INFECTIONS where aircrew show a persistently higher
sickness rate than ground personnel. One factor which must be taken
into account here is that far more attention was paid to upper respiratory
tract infections in flying personnel than in ground personnel. Squadron
medical officers would forbid men with colds to fly, often against the
man’s own wishes, and this policy tended to swell disproportionately the
sickness rates in flying personnel. (See R.A.F. Medical Services
Vol. II, p. 71.) The highest rate of upper respiratory tract infections
was in airman aircrew, and in 1943 this rose to 203 cases per 1,000 of
strength.

The distinction between flying and ground personnel is less clear cut
in PNEUMONIA rates. Airman aircrew showed a consistently higher
incidence than airman ground personnel, particularly in 1944 when the
ratio was 10 per 1,000 for airman aircrew to 6 per 1,000 for ground
personnel. There was virtually no difference between the incidences for
G.D. officers and officers of other branches.

There was little difference in the TUBERCULOSIS incidence in the four
groups. The highest incidence again was in airman aircrew and in this
group there were nearly 5 cases per 1,000 of strength in 1943.

VENEREAL DISEASE rates were higher among airmen than among
officers. All groups showed a rising incidence as the war progressed.

TaBLE 15(a)
R.A.F. Incidence of Diseases in the Various Trade Groups, 1939-41

588 CASUALTIES AND MEDICAL STATISTICS

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589

AIRMEN

OFFICERS

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590 CASUALTIES AND MEDICAL STATISTICS

TaBLe 15(b)
R.A.F. Incidence of Sickness and Injury among Officers, Airman Aircrew

and Ground Personnel, 1942-45

DISEASES

Upper respiratory tract
infections 3 F

Pneumonia

Tuberculosis, all types.

Venereal diseases

Other infections

Septic conditions

1943

Gastric and duodenal ulcers 1942
and their complications .

Alimentary system

Other conditions

Circulatory System

Respiratory system

Allergy, diseases of

Urinary system

Generative system

THE R.A.F. MEDICAL SERVICES 591

Tasie 15(b)—(contd.)

R.A.F. Incidence of Sickness and Injury among Officers, Airman Aircrew
and Ground Personnel, 1942-45

OFFICERS AIRMEN
General Average,
duties | Other Ground | Total

branch | branches] Aircrew |personnel] Force
Locomotor system
Rheumaticgroupofdiseases 1942
1943

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592 CASUALTIES AND MEDICAL STATISTICS

TABLE 15(b)—(contd.)

R.A.F, Incidence of Sickness and Injury among Officers, Airman Aircrew
and Ground Personnel, 1942-45

OFFICERS AIRMEN
General Average,
duties | Other Ground | Total
branch | branches} Aircrew |personnel| Force
All other diseases and 1942 24°0 18-2 13°6 18-4 18:0
unclassified conditions . 1943 18-9 21°0 15°9 20°7 20°!
1944 | 20°2 22°5 19°9 2474 23°6
1945 Bien 24°7 25°0 25°9 26-0
Total of All Diseases . + 1942 | 410°2 | 318°3 388-4 380-0 | 379°0
1943 | 403°7 | 395°4 | 492°7 | 435°7 | 439°6
1944 | 408-8 | 402-5 | 540°5 | 479°6 | 480°5
1945 | 322°3 | 373°3 | 349°4 | 388-6 | 380°6
INJURIES. : : - 1942 | 224-8 25°§ | 145°7 37°0 51-3
1943 | 196-4 25°7 | 164°8 40°2 584
1944 | 186-3 417 | 15973 52°5 70°4
1945 | 84°9 26-1 86-4 38°9 45°72
Total of All Disabilities + 1942 | 635°0 343°8 534°. 417°0 430°3
1943 | 600-1 | 421'1 | 657-4 | 475°9 | 498-0
1944 | 595°1 | 444°2 | 699°8 | 532°0 | 550°9
1945 | 407°t | 399°4 | 435°7 | 427°5 | 425°8

There was little difference between the rates for airman aircrew and
airman ground personnel, but G.D. officers showed a considerably
higher incidence than ground officers. The younger average age of G.D.
officers, the ‘devil-may-care’ attitude engendered by the risks involved
in their duties, the element of hero worship, the longer duty-free
periods and the absence of marital ties were all factors in the greater
incidence of venereal disease among G.D. officers. (See R.A.F. Medical
Services Vol. II, p. 74.) The sudden rise in incidence among ground
officers towards the end of the war is probably explained by the greater
number serving abroad. In operational units, even those at home,
ground staff showed a higher rate than in non-operational ones. It is hard
to know why this should have been so, but it may have been due to the
kind of example of the aircrews with whom they were working.

The composite table OTHER INFECTIONS shows little significant
variation among the four groups. There was a considerable fall in
incidence in all groups in 1945.

SEPTIC CONDITIONS were consistently lower among the officers but
there was no significant difference between aircrew and ground
personnel,

PEPTIC ULCER was most prevalent among officers on ground duties.
The average age of these officers was greater than that of the G.D.

THE R.A.F. MEDICAL SERVICES 593

officers and furthermore any man who gave a past history suggestive of
dyspepsia was never accepted for aircrew duties. Similarly, the incidence
was higher among airman ground personnel than among airman
aircrew. G.D. officers showed a consistently higher incidence than
airman aircrew.

Other conditions of the ALIMENTARY SYSTEM showed little variation
among the four groups.

Again correlated with average age, the incidence of CIRCULATORY
DISTURBANCES was higher in ground personnel than in flying personnel.
Diseases of the RESPIRATORY SYSTEM, URINARY SYSTEM, GENERATIVE
SYSTEM, LOCOMOTOR SYSTEM and diseases of ALLERGY show no significant
variations among the four groups except in so far as accounted for by
age differences.

The incidence of PSYCHONEUROSES was higher among officers than
among airmen and in the two officer groups the G.D. officers generally
had the higher rate. There was little difference between airman aircrew
and airman ground personnel. Flying stress accounts for the high inci-
dence in G.D. officers and it was found that emotional tension was more
important than physical fatigue. Exhaustion, air-sickness, cold, injury
and the effects of altitude were subsidiary factors. The incidence was
highest in operational commands and highest of all in Bomber Command.
The subject of ‘Flying Stress’ is discussed more fully in R.A.F. Vol. II
in this series, Chapter 1 (p. 122 ff.), while details of the relative incidence
by crew category and by Commands is given in Medicine and Pathology
(pp. 384-5).

PSYCHOSES occurred at a fairly constant rate of from o- 5-1-0 per 1,000
of strength for all groups.

PSYCHOPATHIC PERSONALITIES were found chiefly among the airman
ground personnel. Men in the other groups had all been selected and
medically screened and this tended to lower the number with such
disorders in these groups. Similarly, men with mental defect are unlikely
to progress beyond the airman ground personnel category.

EPILEPSY occurred slightly more frequently in airman ground personnel
than in the other groups.

ORGANIC NERVOUS DISEASES are directly related to the average ages of
the group; the highest rate is in the officers engaged on ground duties,
followed by airman ground personnel, G.D. officers and airman
aircrew.

EAR, NOSE AND THROAT conditions showed a consistently higher
incidence among aircrew than among ground personnel. The importance
of efficient hearing in aircrew is obvious and there was a tendency for
aircrew to report sick (quite rightly) with ear complaints which would
not have troubled ground personnel unduly. The same factors which
led to a higher incidence of upper respiratory tract infections in aircrew

594 CASUALTIES AND MEDICAL STATISTICS

also led to a high incidence of ear infections and sinusitis. The necessity
for the constant wearing of earphones in aircraft was shown to be an
important factor in causing and aggravating otitis externa. Otitic
barotrauma—the effect on the eardrum of rapidly altering altitude
without adequate compensation by the Eustachian apparatus—was a
considerable cause of aural morbidity among aircrew.

Airmen in both groups had a higher incidence of SKIN DISEASE than
officers. This is related to the poorer living conditions of airmen and the
greater prevalence of such conditions as impetigo, scabies, tinea and
pediculosis.

The INJURY RATE among aircrew was several times that of ground
personnel. The highest incidence was among G.D. officers.

THE R.A.F. MEDICAL SERVICES 595

Final Invalidings in the R.A-F., 1939-45

Table 16 records the final invalidings from the R.A.F. during the war
and shows the causes leading to invaliding, the total number of cases, the
total number of invalidings, the invaliding rate per cent. of cases and the
invaliding incidence per 1,000 of strength for each year. The figures
refer to the total force. Any man serving overseas who required invalid-
ing from the Service was first transferred tothe United Kingdom before
invaliding action could be taken.

The number of men invalided from the R.A.F. during the war years
was 73,868. Of this number 72,459 or 98 per cent. were invalided as a
result of disease and 1,140 or 1-5 per cent. as a result of injury.

The group of NERVOUS SYSTEM AND MENTAL DISEASES led to 24,807
invalidings or about one third of all invalidings. PsYCHONEUROSES were
the most important cause of invaliding and were responsible for 16 per
cent. of total invalidings due to disease. The invaliding incidence per
1,000 of strength due to psychoneuroses showed a considerable rise in
1941 and maintained this higher level for the remainder of the war.
All psychiatric conditions had a high invaliding rate per cent. of cases.

ALIMENTARY SYSTEM DISEASES were responsible for 11,267 invalidings
or 15 per cent. of the total invalidings due to disease. The majority of
these were cases of PEPTIC ULCER.

Diseases of the LOCOMOTOR SYSTEM were also responsible for a large
number of invalidings—8,252, representing 11 per cent. of the total
invalidings due to disease. DEFORMITIES and DISEASES OF JOINTS were the
most prominent conditions.

There were 6,362 invalidings due to PULMONARY TUBERCULOSIS and
this represents an invaliding rate per cent. of cases of 83-1. TUBERCULOSIS
IN OTHER SITES was responsible for 862 invalidings with an invaliding
rate per cent. of cases of 43-9.

There were 5,025 invalidings due to diseases of the RESPIRATORY
SYSTEM. BRONCHITIS was responsible for the majority of these cases.

The incidence of total invalidings due to disease rose from 7-9 per
1,000 of strength in 1939 to 14°9 per 1,000 of strength in 1941. It then
remained fairly steady until 1945 when there was a further rise to 18-8
per 1,000 of strength. The end of the war against Germany (May 1945)
and Japan (August 1945) undoubtedly influenced standards adopted by
medical boards.

20CMS

596 CASUALTIES AND MEDICAL STATISTICS

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597

THE R.A.F. MEDICAL SERVICES

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598 CASUALTIES AND MEDICAL STATISTICS

Deaths in the Royal Air Force, 1939-45

Table 17 is an analysis of deaths over the war period by disease and
injury groups for the total force. The number of cases, the number of
deaths and the fatality rate per cent. of cases are shown and the incidence
of deaths per 1,000 of strength for each year. The number of deaths from
all causes in the various geographical areas are shown in Tables 1 and 2.

There were 74,797 deaths during the war, 71,093 being caused by
injuries and 3,704 by disease.

Of the ACUTE INFECTIONS, the enteric fevers had the highest fatality
rate; the 150 deaths from this cause represented a death rate of 8-1 per
cent. of cases. There were only 125 deaths from malaria out of 74,717
cases.

TUBERCULOSIS caused more deaths than any other single disease—a
total of 413 deaths from pulmonary tuberculosis and from tuberculosis
in other sites. It must be remembered that most cases of tuberculosis
were invalided from the Service after six months so that the mortality
rate recorded here is not the true mortality rate.

As would be expected, diseases of the MYOCARDIUM had a high fatality
rate of 23-2 per cent.

The number of deaths due to disease of the BLOOD VESSELS, a group
which includes hypertension and varicose veins, is only 57. This is a
misleading figure, however, as all deaths due to vascular lesions of the
brain are included under Organic Nervous Diseases; many of these
deaths must have been due primarily to hypertension.

The deaths recorded under diseases of the URINARY SYSTEM were
mainly due to the various forms of nephritis.

The group cysTs AND TUMOURS includes all malignant growths and
was responsible for 388 deaths.

Deaths due to INJURIES are discussed on pages 549 et seq.

599

THE R.A.F. MEDICAL SERVICES

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600 CASUALTIES AND MEDICAL STATISTICS

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THE R.A.F. MEDICAL SERVICES 601

II. THE WOMEN’S AUXILIARY AIR FORCE

Before the Women’s Auxiliary Air Force was formed, a nucleus known
as the Royal Air Force Companies existed in the Auxiliary Territorial
Service and was identified by a blue shoulder flash. On June 28, 1939,
the Women’s Auxiliary Air Force was formed with the object of
releasing man-power in the Royal Air Force wherever practicable by
substituting women. Service was for a period of four years, but the
personnel were not subject to military law and could, if they chose,
resign from the Service. At the end of the four years they were allowed
to take their discharge or enrol for the duration of the war, having
declared their willingness to serve in any part of the United Kingdom or
overseas. There was no medical examination on enrolment but recruits
were required to furnish a satisfactory health certificate from their
regular doctors. Age limits were from 18-43 years but individuals with
service in the War of 1914-18 were eligible up to the age of 50.

At the beginning of the war all volunteers were embodied into the
Service and were medically examined by Royal Air Force medical
officers. The medical standards were the same as for airman recruits
with appropriate modifications, that is, the standards accepted were
Grade I, Grade II general service and Grade II home service only.
All new volunteers were examined by Service medical officers at the
Women’s Auxiliary Air Force Centres opened for the purpose.

In the early years of the war W.A.A.F. personnel were accommodated
in married quarters on stations or were billeted out. Further information
may be obtained from the R.A.F. Vol. I in this Series, Chapter 9.

The average strength of the Women’s Auxiliary Air Force during the
war months of 1939 was 2,300, but the Force expanded rapidly and by
1943 the average strength was 178,689. Thereafter, there was a slight
decrease in numbers to 173,066 in 1944 and a fall to an average strength

of 142,045 in 1945.
Sickness in the W.A.A.F., 1939-45

Table 18 is an analysis of sickness in the W.A.A.F. during the war;
the rates per 1,000 are also shown in diagram form in Chart 5. The table
is constructed on the same lines as Table 1 and the R.A.F. figures are
shown here for ease of comparison between the two forces; it should be
noted, however, that in the war period of 1939 the numbers involved
were so small that true comparison is not possible.

In 1940 there was a higher incidence of sickness in the W.A.A.F. than
during any other war year and both the incidence of total sickness and
that of sickness over 48 hours’ duration were roughly double the cor-
responding figures for the R.A.F. However, the average number of days’
treatment before return to duty was appreciably less in the W.A.A.F.

602 CASUALTIES AND MEDICAL STATISTICS

CHART 5
SICKNESS IN THE WOMEN’S AUXILIARY AIR FORCE,
1939-45
Incidence
per 1,000
per annum
1,600

1,200

800
SICKNESS UNDER

48 HRS. DURATION

600

SICKNESS OVER
48 HRS. DURATION

1939 1940 1941 1942 1943 1944 1945

THE R.A.F. MEDICAL SERVICES 603

CHART 6

WOMEN’S AUXILIARY AIR FORCE.—NUMBER OF SICK
DAILY PER 1,000 OF STRENGTH, 1939-45

Rate per
1,000 of
Strength

30

25

1939 1940 1941 1942 1943 1944 1945

604 CASUALTIES AND MEDICAL STATISTICS

than in the R.A.F. and this may indicate a greater proportion of minor
ailments in the W.A.A.F.

In 1941 there was a considerable fall in the incidence of total sickness
and in the incidence of sickness over 48 hours’ duration. This decrease in
the incidence of total sickness was maintained throughout the remaining
years of the war and in 1945 was 692 per 1,000 of strength compared
with 1,512 per 1,000 in 1940. The incidence of sickness over 48 hours’
duration showed little difference over the years 1941-45 and averaged
566 per 1,000 of strength. Although the incidence of sickness is con-
sistently higher in the W.A.A.F. than in the R.A.F. the actual wastage
as measured by the average number of days’ sickness per head and by
the number of sick daily (see also Chart 6) per 1,000 of strength was
greater in the R.A.F. in 1943 and 1944. These were the years when a
large proportion of the R.A.F. was serving overseas and when injuries
tended to swell the sickness rates.

Final invaliding incidences are also shown in this table. The causes
of final invaliding are shown separately in Table 23. Until 1941 the
incidence of final invalidings was below the incidence in the R.A.F. but
for the remaining war years the rate was higher than in the R.A.F.

The death rate in the W.A.A.F. never approached that in the R.A.F.
as W.A.A.F. personnel were never engaged in primarily combatant
duties. The highest death rate was in 1942 when there were 0-9 deaths
per 1,000 of strength.

605

THE R.A.F. MEDICAL SERVICES

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THE R.A.F. MEDICAL SERVICES 607

SICKNESS AS A WHOLE IN THE W.A.A.F., 1939-45

Table 19(a) is the main nosological table analysing the incidence of
disease and injury for the war period. The number of W.A.A.F.
personnel who served abroad was small and no separate table has been
prepared for those who did go overseas. The arrangement of the table is
similar to that of the nosological table for the Royal Air Force (Table (3a))
but an additional section relating to conditions peculiar to women has
been included. The nosological table does not record cases of disease or
injury of less than 48 hours’ duration, except where these resulted
in death or invaliding.

The disease groups shown in Table 19(b) have been extracted from the
main nosological table and are arranged in descending order of incidence.
The percentage contribution which each group makes to the total of all
diseases is also shown.

As in the Royal Air Force, INFECTIONS OF THE UPPER RESPIRATORY
TRACT form the largest single group. The highest incidence was in 1940
when there were 244 cases per 1,000 of strength. The winter of 1940
was severe. The two mild epidemics of influenza which affected the
country as a whole in 1940 and 1943 are reflected in the influenza
figures for the W.A.A.F.

OTHER INFECTIOUS DISEASES do not figure so largely in the W.A.A.F.
tables as in the R.A.F. tables because so few W.A.A.F. personnel were
called upon to serve abroad. Thus only a relatively insignificant number
of tropical diseases are recorded. More than half the total of infectious
diseases is made up of virus infections, mumps, measles, chicken pox
and rubella being the common ones. (See Table 20, Certain Infectious
Diseases in the W.A.A.F., 1939-45.)

PNEUMONIA was consistently less prevalent in the W.A.A.F. than in
the R.A.F. The lowest incidence of all was in 1944 when the R.A.F.
incidence was very high.

The incidence of TUBERCULOSIS tended to be higher than the incidence
in the R.A.F. The average incidence of pulmonary tuberculosis in the
W.A.A.F. over the whole war period was 2-46 cases per 1,000 of strength
as against 1 8 cases per 1,000 in the R.A.F. The highest incidence was in
1942 when there were 3-22 cases per 1,000 of strength.

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THE R.A.F. MEDICAL SERVICES

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618 CASUALTIES AND MEDICAL STATISTICS

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620 CASUALTIES AND MEDICAL STATISTICS

The VENEREAL DISEASE incidence in the W.A.A.F. was considerably
lower than in the R.A.F. at home—the average incidence for all venereal
diseases over the whole war period was 2:36 per 1,000 as compared with
8-7 per 1,000 in the R.A.F. The highest rate was recorded in 1942 when
there were 3°57 cases per 1,000.

The incidence of ALIMENTARY SYSTEM DISEASES was higher than in the
R.A.F. and the relative importance of the conditions making up this
group was different. Both GASTRIC and DUODENAL ULCER figured less
prominently than in the R.A.F. tables; thus the incidence of duodenal
ulcer averaged 0-43 cases per 1,000 compared with 3:9 cases per 1,000
in the R.A.F. APPENDICITIS, on the other hand, was more common in the
W.A.A.F.—an average of 13:28 cases per 1,000 as opposed to 5 per
1,000 in the R.A.F. As would be expected cases of HERNIA were very
much less common in the W.A.A.F. than in the R.A.F. The biggest
difference between the two sexes was in the Group of OTHER INTESTINAL
CONDITIONS which is largely made up of cases of enteritis—the average
incidence in the W.A.A.F. was 23 per 1,000 compared with 9 per 1,000
in the R.A.F.

There was a high incidence of diseases of the RESPIRATORY SYSTEM,
particularly of bronchitis. In 1940 the incidence of bronchitis was 42-8
per 1,000 compared with a R.A.F. figure of 11-5 per 1,000. The in-
cidence of diseases of the respiratory system was at its lowest in 1942
but rose again in 1943 and remained high until the end of the war.

The incidence of URINARY SYSTEM DISEASES was much higher than in
the R.A.F., chiefly due to a considerably higher incidence of cystitis and
pyelitis.

The incidence of DISEASES OF THE LOCOMOTOR SYSTEM differed little
from year to year and was slightly higher than the incidence in the
R.A.F. at home. Diseases of the rheumatic group were more prominent
than in the R.A.F., but joint conditions, and particularly internal
derangement of the knee joint, were less common.

There was a high incidence of PSYCHONEUROSIS throughout with a
peak in 1943 of 14°56 cases per 1,000. The incidence of PSYCHOPATHIC
PERSONALITY, too, was high with a peak of 4-48 cases per 1,000 in 1945.
The incidence of psycHoses did not differ significantly from the
incidence in the R.A.F.

The total incidence of EAR DISEASES was roughly the same as in the
R.A.F. but the relative importance of acute and chronic otitis media
was different in the two sexes; acute otitis media was consistently more
common in the W.A.A.F. whereas the R.A.F. showed a higher
incidence of the chronic form.

SKIN DISEASES rose steadily in incidence to reach a peak in 1942 with
an incidence of 40 per 1,000. There was a considerable fall in incidence
in the succeeding years. It must be remembered that it is impossible to

THE R.A.F. MEDICAL SERVICES 621

achieve a true picture of the incidence of skin diseases merely by
considering those cases which were admitted for over forty-eight hours;
most skin diseases are treated as out-patients and only the more serious
cases require admission. Thus, although in 1942 more than half the
admissions were due to SCABIES, the considerable reduction in incidence
of scabies in 1943 may not reflect any reduction in the true incidence of
scabies in that year but merely improved methods of treatment enabling
more cases to be treated as out-patients. Actually, 1943 was the year in
which benzyl benzoate first became generally adopted in the R.A.F. for
treatment of scabies and its ease of application and absence of complica-
tions were certainly responsible for fewer admissions for scabies.

PEDICULOSIS was known to be very common in W.A.A.F. recruits and
yet as its treatment is almost invariably possible in the out-patients’
department the nosological table shows only a small number of cases.

INJURIES are classified on the same lines as the R.A.F. injuries. The
numbers were relatively small as W.A.A.F. personnel were not employed
on operational flights.

Table 20 shows the annual incidence of certain infectious diseases for
the W.A.A.F. It is constructed on similar lines to the corresponding
R.A.F. table (‘Table 4).

TABLE 19(b)

Number of Fresh Cases, Incidence and Percentage
Distribution of Disease, W.A.A.F.

Number Incidence]
CAUSES of 1,000 per | Percentage of
Cases Annum all Diseases

Upper Respiratory Tract ee s 104,883 163-61 rez
Alimentary System. . 39,783 62-06 11°8
Diseases Peculiar to Women : . 24,585 38°35 73
Respiratory System. 5 : ‘ 20,987 32°74 6-2
Infectious Diseases. ei is s 19,731 30°78 5 2
Septic Conditions Si x i 5 19,623 30°61 5°
Skin Diseases. a 17,270 26°94 Str
Nervous and Mental Diseases < ‘. 15,805 24°66 4°7
E.N.T. Conditions. E ‘ 5 13,094 20°43 3°9
Locomotor System. * ‘ a 11,991 18-71 3°6
Urinary System . 5 é : 8,222 12°83 24
Circulatory System. ; : . 4,326 6°75 1°3
Diseases of Allergy . A is * 3,037 4°74 09
Eye Conditions . 4 “ ‘ 2,548 3°97 08
Tuberculosis—Pulmonary ls ‘ 1,575 2°46 ors
Tuberculosis—Other than Pulmonary ‘ 507 0-79 oz
Blood and Blood-forming Organs, R.E.

System . : 1,867 2°OX 06
Cystsand Tumours. z 2 s 1,572 2°45 o's
Pneumonia ‘ s : : : 1,440 2°25 o4
Venereal Diseases : A ‘ ‘ 1,511 2°36 o's
Indefinite and General Z 5 r 21,508 33°54 64

Totals ‘ : 3 . 335,865 523°94 100°0

622 CASUALTIES AND MEDICAL STATISTICS

TABLE 20
Certain Infectious Diseases, W.A.A.F., 1939-45—Fresh Cases

Annual Incidence per 1,000 of Strength

1945
Acute anterior poliomyelitis | — _ 0°02 | 0°08 | 0-06 ‘i y
Acute rheumatism . 7 2°72 16 5°21 | 2-0 1°07 0-70
Infective hepatitis . _ 14 | org | 2°39 | 2°65 1°33 2°97
Cerebro-spinal fever _ 08 | 0-5 | 0°35 | o-15 | or12 | O-1g4
Chicken-pox . 2 7 1°6 19 1°44 | 1°58 1°58 | 0-84
Diphtheria. . o-9 08 14 114, | r'1z | 0°58 | 0°66
Encephalitis lethargi ong _ 0-02 | oor | — 07006 | —
German measles. 44 103°4 | 5°4 | 3°92 | 4°73 | 15°54 | 2-18
Measles o-9 65 | 4°3 1°84 | 3°20 1°68 1°69
Mumps a o4 21 2°6 | 4°95 | 2°5. 1°33 1°62
Scarlet Fever . o"9 o9 9 1°64 | 1° 1°39 | 0°49
Smallpox _ — _ _ _

‘Tetanus _ _ — | 0-02 | o-or

Typhus _ - - — | o-or

ACUTE ANTERIOR POLIOMYELITIS had an even lower incidence in the
W.A.A.F. than in the R.A.F.

The highest incidence of ACUTE RHEUMATISM was in 1942 when there
were 666 cases with an incidence of 5-2 per 1,000 of strength. This was
considerably higher than the R.A.F. incidence of 1-2 per 1,000 of
strength but in other years the incidence in the two sexes was roughly
equal.

The major epidemics of INFECTIVE HEPATITIS occurred overseas and
it is not surprising that there is a higher incidence in the R.A.F. In 1945
there were 160 cases in W.A.A.F. personnel serving overseas and this
represents an incidence of 32:4 per 1,000 of strength overseas.

CEREBRO-SPINAL FEVER had an incidence of 0-8 per 1,000 in 1940 and
thereafter declined steadily.

RUBELLA reached the very high incidence of 103-4 per 1,000 in 1940,
when there was a nation-wide epidemic of the disease. There was a
smaller epidemic in 1944 when the incidence was 15-5 per 1,000.

MEASLES showed peak incidences of 6-5 per 1,000 in 1940 and 3-2 per
1,000 in 1943, corresponding with nation-wide epidemics.

There were no cases of SMALLPOX in the W.A.A.F.

THE R.A.F. MEDICAL SERVICES 623

INCIDENCE OF DISEASE AND INJURY
ANALYSED BY AGE GROUPS, 1941-45

Table 21 is an analysis of disease and injury by age groups for the
years 1941-45; data are not available for the years 1939 and 1940.

In all years the highest incidence of sickness is in the under 20 age
group and in both 1943 and 1945 disease and injury in this age group
were at an incidence of nearly 1,400 per 1,000 of strength. The lowest
incidence of sickness was consistently in the age groups 25-29 and 30-34.
There was always a jump in the incidence of sickness in the age group 40—
44 and in most years the rate was higher in this group than in the over 45
age group. A possible explanation of this is that the menopause often
occurs between the ages of 40 and 44 and this would have an effect on a
woman’s general well-being.

The greater liability of the under 20 age group to infection is well
illustrated in the figures for INFECTIONS OF THE UPPER RESPIRATORY
TRACT. The incidence in this group is usually greater than the incidence
in any other age group.

PNEUMONIA, too, was generally more prevalent among those under 20
than in the other age groups, but in 1943 most cases occurred in those
over the age of 45 and in 1944 and 1945 the 35-39 age group suffered
most heavily.

The general picture of PULMONARY TUBERCULOSIS is of a high incidence
in the under 20 age group with a rapid fall to a relatively low incidence
round the age of 30 and a secondary but smaller peak in the late thirties
or early forties. TUBERCULOSIS other than pulmonary shows a somewhat
similar trend.

The age group distribution of VENEREAL DISEASE does not exactly
parallel that of the R.A.F. In the W.A.A.F. the highest incidence is
consistently in the under 20 age group whereas in the R.A.F. there is a
tendency for the incidence to be highest in the next two age groups.

INFECTIVE HEPATITIS was most prevalent in the younger age groups
with a progressive decrease in incidence with increasing age.

POST-INOCULATION EFFECTS, as in the R.A.F., were most common in
the under 20 age group, when the majority of initial Service inoculations
were carried out.

The groups OTHER INFECTIONS and SEPTIC CONDITIONS follow the
general trend with a high incidence in the under 20 age group and a
progressive fall in rates until the late thirties and early forties when
there was a secondary rise.

Diseases of the CIRCULATORY SYSTEM had a very high incidence in the
age groups over 40.

PLEURISY WITH EFFUSION has not been separated from other respiratory
system diseases in the tables. In keeping with tuberculosis and respiratory
tract infections its highest incidence was in the under 20 age group.

624 CASUALTIES AND MEDICAL STATISTICS

Diseases of the URINARY SYSTEM were generally most prevalent in
those under 20 but showed no significant differences between the other
age groups.

DISORDERS OF MENSTRUATION were most common in older women but
also showed a high incidence in the under 20’s. Other diseases peculiar to
women showed similar trends.

PSYCHONEUROSES were least common between the ages of 20 and 30
and rose considerably in incidence in the higher age groups. There was
also a high incidence in the under 20’s.

There appears to be no consistent pattern in the incidence of PSYCHOSES
in the different age groups.

PSYCHOPATHIC PERSONALITIES occurred least frequently between the
ages of 20 and 30. In general, the highest incidences were in the under
20 age group but there was also a marked increase after the age of 30.

MENTAL DEFECT was most common under the age of 20. EPILEPSY
showed a declining incidence with increasing age. ORGANIC NERVOUS
DISEASES were more prominent in the older age groups.

LOCOMOTOR SYSTEM DISEASES, as in the R.A.F., were more prevalent
in the older age groups.

EYE conditions showed no significant difference between the various
age groups.

EAR, NOSE AND THROAT conditions were most common in the under 20
age group and declined steadily with age.

SKIN DISEASES, too, were more common in the younger age groups.

TABLE 21
W.A.A.F. Diseases and Injuries by Age Groups, 1941-45—Rates per 1,000 Strength

THE R.A.F. MEDICAL SERVICES 625
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Venereal Diseases

626 CASUALTIES AND MEDICAL STATISTICS

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TABLE 21 (contd.)
W.A.A.F. Diseases and Injuries by Age Groups, 1941-45—Rates per 1,000 Strength

CASUALTIES AND MEDICAL STATISTICS

AGE GROUPS

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Mental Defect

Epilepsies

Indefinite Aetiology
Organic Nervous Diseases

DISEASES:

Eye

629

THE R.A.F. MEDICAL SERVICES

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630 CASUALTIES AND MEDICAL STATISTICS

INCIDENCE OF DISEASE AMONG W.A.A.F.
OFFICERS AND AIRWOMEN, 1942-45

Table 22 records the incidence of disease per 1,000 of strength for
officers and airwomen for the years 1942-45. Comparisons between the
two groups are of very little value as they have not been standardised
for age.

In the early years of the war the incidence of sickness tended to be
higher in airwomen, but in 1944 and 1945 there was a higher total
incidence of disease among officers.

PSYCHONEUROSES tended to be more prevalent among officers and, as
would be expected, PSYCHOPATHIC PERSONALITIES were more common
among airwomen. VENEREAL DISEASE was much less common in officers
than in airwomen.

FINAL INVALIDINGS, W.A.A.F.

There were 14,072 invalidings from the W.A.A.F. during the war
years and all except 65 were due to disease. The conditions leading to
invaliding are shown in Table 23, which gives the total number of
cases of each condition, the total number invalided, the invaliding rate
per cent. of cases and the invaliding incidence per 1,000 of strength
for each year except 1939, when there were only 9g invalidings.

The total invaliding incidence in 1940 and 1941 was low and compared
favourably with the incidence in the R.A.F.; in 1941, for instance, the
invaliding rate due to disease in the R.A.F. was 14:9 per 1,000 of
strength and in the W.A.A.F. 11-3 per 1,000 of strength. In 1942,
however, there was a big jump in the W.A.A.F. invaliding rate and,
although there was a slight fall in later years, the rate remained high for
the rest of the war. In the early years of the war the W.A.A.F. was
entirely a volunteer force and the increase in invaliding in 1942 may be
in some degree attributed to the introduction of conscription.

DISEASES OF THE NERVOUS SYSTEM AND MENTAL DISEASES aS a group
were responsible for 7,247 invalidings, or just over half the total.
PsYCHONEUROSES accounted for 3,856 of this number and the invaliding
rate per 1,000 of strength for psychoneuroses was much higher than in
the R.A.F. This difference was almost certainly due to the greater
difficulty women experienced in adapting themselves to Service con-
ditions. A considerable proportion of these women had never had a
civilian job and tended to break down rapidly under conditions of
community regimentation. They were usually solitary, shy individuals
with few external interests and dependent on maternal decisions.
They had a tendency to form strong emotional attachments.

631

THE R.A.F. MEDICAL SERVICES

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632 CASUALTIES AND MEDICAL STATISTICS

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THE R.A.F. MEDICAL SERVICES 633

As would be expected the invaliding rate per cent. of cases was very
high for mental diseases, particularly for cases of PSYCHOPATHIC
PERSONALITY and MENTAL DEFECT.

PULMONARY TUBERCULOSIS was second in order of frequency as a
cause of invaliding; there were 1,395 invalidings due to this disease
with an invaliding rate of 76-4 per cent. Tuberculosis in other sites
was responsible for 294 invalidings.

Discharges from the Service due to PREGNANCY do not appear as
invalidings.

DEATHS, W.A.A.F., 1939-45

Table 24 records the number of deaths from the specified causes and
the fatality rate per cent. of cases.

There was a total of 496 deaths in the W.A.A.F. during the war,
287 due to disease and 209 due to injuries. TUBERCULOSIS was the most
important cause of death and was responsible for 68 deaths. Conditions
of the ALIMENTARY SYSTEM led to 46 deaths, of the NERVOUS SYSTEM
and MENTAL DISEASES to 31 deaths, and ACUTE INFECTIONS to 30 deaths.

TABLE 24
Deaths, W.A.A.F., 1939-45

Fatality
Number | Number Rate
CAUSES of of per cent.
Cases Deaths of Cases
DISEASES
Acute Infections S 5 , z . 22,088 jo o°13
Pneumonia 2 . ‘ 5 5 1,552 21 1°82
Pulmonary Tuberculosis | a : 4 1,825 29 1°58
Tuberculosis (other ate) z 4 “ 574 39 6-8
Alimentary System . a a 5 38,971 46 orn
Circulatory System . - 4,491 12 026
Blood, Blood-forming Organs, Spleen « and
Reticulo-Endothelial System . F 1,942 16 0-82
Respiratory System . 2 21,746 10 0°04
Nervous System and Mental Diseases . e 16,441 31 0:18
Urinary System - e * 8,444 9 or10
Cysts and Tumours . : < : 1,636 20 1°22
Diseases peculiar to women + : : 25,241 10 0°03
All other Diseases. : x . 5 199,948 14 0007
Total Diseases . ° . . 3 - | 344,899 287 0°08
INJURIES. ‘ ) a ¥ . 23,162 o
Other Conditions . f f ¢ : 2ir ms *

Total Diseases and Injuries . s . | 368,272 496 o'13

The Emergency Medical Services

A WAR-TIME STUDY OF CAUSES OF
ADMISSIONS TO HOSPITAL

An Analysis of the Records of E.M.S. In-Patients, 1940-47

by Eileen M. Brooke, M.Sc.

21*CMS

CONTENTS

INTRODUCTION 641
PART I. SERVICE PATIENTS 647
CAUSES OF ADMISSION BY DISEASE GROUP 647
Tabler . 2 2 3 ‘ . 7 2 . - 649
SELECTED CAUSES OF ADMISSION BY DIsEASE GROUP 651
Tuberculosis 651
Tables 2-4 s : : . F 3 5 - 651-653
Venereal Diseases 655
Tables 5 and 6 : : ‘ : . . + 655
Influenza, Colds and ra aN 656
Tables 7-10 5 ¥ 4 , - 656-659
Scabies 660
Tablestrand12 t a i A A + 660-661
Other Infective Diseases 662
Tables 13-15. . . : % . : < oe
Rheumatic Diseases
Tables 16-21. ‘ teen
Neoplasms, Diabetes, ea. and witiak General bia Endocrine 668
Diseases
Tables 22 and 23; . 5 : . 669-670

Diseases of the Nervous System ak Functional Disorders of the 670
Stomach and Intestines

Tables 24-29. ‘ ‘ é : E 7 - 670-677
Diseases of the Eyes and Ears 674
Diseases of the Heart and Arteries 678

Table 30 . é i 4 : . . q - 678
Diseases of the Veins 679

Tables 31 and32—Ot; 7 . ‘ . 7 » 679,680
Respiratory Diseases 679

Tables 33-40. . : i ; : , - 681-688
Acute Hepatitis and Jaundice 687

Tables 41-47. : 4 ° : ‘ ts + 689-699
Hernia 700

Tables 48-51. . 5 3 : 3 + 7O1,702
Gastric and Duodenal Ulcers 703

Tables 52 and 53 “ : + 704
Gastro-enteritis, Appendicitis daa eee Digestive Diseases 705

Tables 54-58 . . é . 2 ‘ : « 706~709

637

638 CASUALTIES AND MEDICAL STATISTICS

Diseases of the Female Genital Organs and Normal and Abnormal 710

Childbearing
Tables 59-61. 5 fs : 7 ‘ . + 710-712
Other Genito-Urinary Diseases 712
Tables 62-64 . é F . 3 + 712,713
Diseases of the Skin and Cellular Tissue 714
Tables 65-69. Hy ‘ 5 7 ‘ + 714-718
Diseases of Bones, Joints and Muscles 716
Tables 70-71. : : . : . : » 719,720
Congenital Malformations . : : ‘ : z + 721
Ill-Defined Symptoms 721
Tables 72 and 73 . ‘ ° + 722,723

Appendix I Causes of Admission of Service Patients to E.M.S. 724
Hospitals, 1940-47

ADMISSIONS FOR INJURIES 740
All Injuries 740
Table 74 . fi . : 5 F cj - : : 2
Head Injuries 743
Tables 75-78. : : : : i ‘ - 743-747
Fractures other than Skull 748
Table 79 . : . : : ‘ A , . - 748

(a) Fractures and Fracture-dislocations of the vertebral column 749
Tables 80-83. . : ‘ + 749-752

(b) Fractures of Trunk Bones other than Sin 752
Table 84 . ‘ . , : : + 752

(c) Fractures of Vepe b Limb or Limbs 753
Tables 85-88 . 7 : : + 754-759

(d) Fractures of the Lower Limbs 760
Tables 89-92. : . . . . - 761-765

(e) Multiple Fractures 766
Tables 93 andg4 x. 7 , 5 ‘ z . 767-769

(f) Follow-up of cases of Fracture of either an ada oralowerlimb 768
Tables 95-99 . a : . ; - 771-776
Acute Poisoning f . . i : : - 777
Burns 728
Tables 100-102 5 . : : ci : + 778-780
Other Injuries 780

Tables 103-108 ‘ : : , é . - 781-788

THE EMERGENCY MEDICAL SERVICES 639

Homologous Serum Jaundice 787
Tables 1og-111 . ; : 5 . 789~792
External Causes of Accidents 793
Tables 112-117 5 - : . + 794-799
PART II. CIVILIAN PATIENTS 800
ADMISSIONS FOR DISEASES 800
Table 118. ; F : £ , F ‘ ; . 803
ADMISSIONS FOR INJURIES 804
Tables 119-124 : . 805-812
AppendixII (a) Causes of Admission (Diseases) of Civilian Patients
to E.M.S. Hospitals, 1940-45 . : ‘ . 814-819
(b) Causes of Admission (Injuries) of Civilian Patients
to E.M.S. Hospitals, 1940-46 . H . 820-821
CONCLUSION he ie Ae ‘ , » . é . 822

References 2 . , : ‘ 5 3 . ei . 824

INTRODUCTION

‘Up to the present time the statistics of hospitals have been kept on
no uniform plan. Every hospital has followed its own nomenclature and
classification of diseases, and there has been no reduction on any
uniform model of the vast amount of observations which have been
made in these establishments. So far as relates either to medical or
sanitary science, these observations in their present state bear exactly
the same relation as an indefinite number of astronomical observations
made without concert and reduced to no common standard, would
bear to the progress of astronomy. The material exists, but it is inac-
cessible.’

Thus wrote Florence Nightingale, in presenting to the Fourth
Session of the International Statistical Congress of 1860, a ‘Proposal
for an Uniform Plan of Hospital Statistics’. Her remarks were probably
scarcely less applicable in 1939 at the outbreak of the Second World
War than when they were written. Two problems were indicated by
Miss Nightingale; firstly, the need for providing a uniform classification
of diseases for use in hospitals, and secondly that for collecting observa-
tions in a uniform way. Although a uniform classification had existed
for about eighty years, it related primarily to causes of death and was
unsuitable for morbidity coding, while, with the possible exception of
mental hospitals, there was a complete lack of uniformity in the keeping
of medical records.

Early attempts at classifying diseases were made by de Lacroix
(1706-77), Linnaeus (1707-78) and Cullen (1710-90). William Farr,
first Medical Statistician to the General Register Office, was greatly
impressed with the need for a classification of diseases for statistical
purposes; and in 1853 at the First International Statistical Congress
he laid down the principles which he considered should be followed in
producing such a List. The Congress, recognising the value of a
uniform classification, asked Farr and d’Espine of Geneva to prepare
classifications for consideration at the Congress of 1855. D’Espine’s
grouping was based on the nature of diseases; for example, gouty,
herpetic, haematic, etc. Farr’s list contained five groups:

(1) epidemic diseases

(2) constitutional (or general) diseases

(3) local diseases according to anatomical site

(4) developmental diseases

(5) diseases which were the direct result of violence.
The Congress of 1855 adopted a list of 139 classes arranged in accord-
ance with Farr’s proposals. Subsequent congresses in 1864, 1874, 1880

641

642 CASUALTIES AND MEDICAL STATISTICS

and 1886 revised the original list, but without departing from the
original structure. When the International Congress was replaced by
the International Statistical Institute in 1891, a committee under the
chairmanship of Dr. Bertillon was requested to prepare a classification
of causes of death. The result, which was adopted in 1893, followed
Farr’s principle of separating general diseases from those which attacked
an isolated organ. Subsequent revisions of the classification gradually
began to come into international use, and in 1923, following Bertillon’s
death, it was agreed that responsibility for the classification should be
shared by the International Statistical Institute and the Health Organ-
isation of the League of Nations. While interest had centred on a
classification of causes of death, the necessity had not been overlooked
for extending the classification to diseases which cause disability,
without usually being fatal. Two difficulties arose in this connexion,
the lack of definition of what constitutes a sick person and the lack of
a suitable body of material to classify, since except for certain infectious
diseases, there has been no registration of sickness comparable with
the registration of cause of death. In both 1900 and 1909 when the
Classification of Causes of Death was revised, attempts were made to
provide a parallel list for coding illnesses which are generally non-fatal,
but they met with little success. In 1936 Canada published a ‘Standard
Morbidity Code’ for use in the Dominion Council of Health, and in
1944 the Medical Research Council issued a ‘Provisional Classification
of Diseases and Injuries for use in compiling Morbidity Statistics’.
This was the classification used to code causes of admission to Emergency
Medical Service Hospitals—the subject matter of the present report.

The experience gained from using this list was subsequently helpful
in the preparation by a specialist committee of the World Health Organi-
sation of the Manual of the International Statistical Classification of
Diseases, Injuries and Causes of Death (Sixth Revision of the Inter-
national List of Diseases, Injuries and Causes of Death). This classifi-
cation, which was adopted in 1948, came into use in 1950 for the prepara-
tion by Member States of the World Health Organisation of their
official statistics of both mortality and morbidity.

The second need to which Miss Nightingale referred, namely that of
obtaining a body of observations recorded and abstracted in a uniform
way was largely overcome when the Emergency Medical Services were
brought into operation in 1939. With the increasing tension in Europe
during 1937-39, the possibility of a second European war could not
be ignored. The experience of the Spanish Civil War showed the need
for defending the civilian population against aerial attack and for
providing treatment for casualties. Early in 1938 medical officers of the
Ministry of Health surveyed the existing hospital accommodation in
England and Wales, and recorded 3,128 hospitals and institutions

THE EMERGENCY MEDICAL SERVICES 643

containing 400,000-500,000 beds of which 130,000 were in mental
hospitals. Hospitals were divided into two categories, voluntary and
municipal. The former class comprised general and special hospitals
run by voluntary contributions; the latter consisted of general hospitals,
those for infectious diseases, tuberculosis hospitals and sanatoria and
maternity and child welfare institutions, whose support was derived
partly from Ministry grants and partly from local rates. Both classes co-
operated fully in the Survey. Prior to June 1938, local authorities were
required to provide accommodation for the treatment of casualties as
part of their air-raid precautions, but in June 1938 the Ministry of
Health assumed responsibility for the scheme.

It had been estimated that in the event of war immediate accommoda-
tion should be available for 300,000 civilian casualties, in addition to the
possible requirements of the Fighting Services. This was to be done in
three ways, by discharging all ambulant patients and those who could
safely be sent home, thus clearing about 100,000 beds, by ‘crowding’
hospitals by introducing 110,000 extra beds and by building new
hutted hospitals to hold 90,000 beds. When the war broke out the
Emergency Medical Services had retained 2,370 hospitals with 492,570
beds, of which 309,354 were suitable for casualties, the rest being mostly
in Infectious Diseases hospitals and sanatoria. Within a week 187,000
extra beds had been provided by ‘crowding’.

As the expected aerial bombardment did not materialise a number of
hospitals were released for the treatment of ordinary civilian sick, so
that by January 1940 there were 1,207 hospitals remaining in the
scheme, with 407,612 beds, of which 262,859 were for casualties. By
the end of 1942 a further reduction had taken place, leaving 892
hospitals and institutions with 278,761 beds. The numbers then
remained fairly constant, but from 1945 onwards there was a steady
decline, so that by the end of 1947 329 hospitals were left in the
service containing 18,000 beds, which were, however, available for
ordinary civilian use when not required for E.M.S. patients. The
Emergency Hospital Services were finally merged in the National
Health Service in July 1948.

In addition to ordinary facilities for the treatment of casualties, a
suumber of special centres were set up, either as separate hospitals or as
wings of existing hospitals. These numbered about 120 in all, the main
groups being for cases requiring orthopaedic surgery (20), for skin
diseases (20), neurosis (14), maxillo-facial injuries (12), head injuries
(11) and chest injuries (10).

The main classes of E.M.S. patients were:

(a) Civilians, including regular Police, suffering from war injuries and
injuries incurred in the performance of Civil Defence duties.

644 CASUALTIES AND MEDICAL STATISTICS

(b) Service men and women, whether sick or injured, including
repatriated prisoners-of-war, Dominion and Allied Forces,
including their auxiliary medical personnel.

(c) Merchant Navy officers and men.

(d) Evacuee children, refugees from Gibraltar and the Channel
Islands, sick civilians moved from target areas, transferred war
workers and those in agricultural or forestry camps.

(e) Persons whom, in the interest of the war effort, it was necessary
to restore to health and full working capacity as quickly as pos-
sible, notably cases of fractures and certain other types of injury
occurring among manual workers in factories and full-time Civil
Defence workers.

The medical records of most of these patients, whether Service or
civilian, receiving in-patient treatment in E.M.S. hospitals were col-
lected at the Ministry of Pensions either during or after the war. Where
a patient was admitted to hospital once or several times, the case papers
for each admission were put in a separate envelope, these being filed
alphabetically according to surname. A one-fifth sample of admissions
was made by taking the files in order, assigning serial numbers to the
admissions occurring in each half-year, and extracting all whose serial
number ended in o or 5. Three other methods of sampling suggested
themselves, to select certain letters and take all cases filed under these,
to take all admissions to hospital on certain days or to select a number of
hospitals and take all their admissions. All these methods would have
introduced a bias, the first because of the preponderance of certain
initial letters in Welsh and Scotch surnames, the second because of the
seasonal variation in disease incidence and the last because of the greater
prevalence of some diseases in particular regions, as of jaundice in the
eastern counties. If a patient, after discharge, re-entered hospital for
further treatment of the same condition within a week of discharge, the
second visit was not counted as a separate admission. In the compara-
tively rare event of the case papers not containing a definite diagnosis,
the envelope next in the series was taken as a substitute. It may reason-
ably be claimed that, as far as the documents were concerned, the sample
was a random one.

The information gained from the case papers was entered on a card,
the following items being recorded:

Dates of admission and discharge.

Sex. Age. Service or Civilian case.

Branch of Service. Rank.

Civil Defence Service or other occupation, for civilian patients.
Name of Hospital and county in which situated.

THE EMERGENCY MEDICAL SERVICES 645

Result of treatment, e.g., return to duty, regraded, discharged from
the Forces, etc.

Number of days of in-patient treatment, including time spent in
other hospitals and convalescent homes, and, in the case of men
with injuries received abroad, the time from date of injury to
discharge from hospital. Space was provided for showing the
names of hospitals to which the patients were transferred.

The final diagnosis of the patient’s condition was entered under four
headings by inserting the appropriate code number from the M.R.C.
Provisional Classification of Diseases, Injuries and Causes of Death.

(1) Principal disease or injury causing admission.
(2) Principal complications of (1).

(3) Principal accessory acute disease or injury.
(4) Principal chronic disease.

These four items, and any other pathological conditions mentioned
in the case history, were recorded in words on the back of the card. For
research purposes it was found desirable to record the theatre of war in
which an injury was received and also whether or not a blood trans-
fusion was given.

The work of reading the case papers, filling in cards and coding
diseases was done by clerks with occasional recourse to medical advice.
It was usually easy to find which was the principal cause of admission,
but in cases where two acute conditions were given as joint causes, the
rules for selection on page 9 of the M.R.C. Classification were followed.
With coding rules established and a good medical dictionary available,
lack of previous knowledge was not found to be an insuperable diffi-
culty. An average coder could easily read and record fifty cases a day,
while quicker or more experienced workers achieved a rate of seventy
or over. This may have some bearing on problems of hospital adminis-
tration, for if hospital records were designed to include a uniform front
sheet to the case history it should be possible for statistical records to be
abstracted at a sufficiently high rate to make feasible the collection of
hospital statistics on a national scale. The form used in the Hospital
In-patient Enquiry conducted as an experiment by the General Register
Office was designed for use also as a front sheet for case histories with
intention that the section dealing with diagnosis should be completed
under the direction of a doctor. Expense is lessened and uniformity
enhanced if coding is done at a central office.

The objection raised against hospital statistics of causes of admission
is that they are biased because of the method of selection of cases for
in-patient treatment. Under ordinary circumstances the more serious
cases are sent to hospital, or those which for various reasons cannot
be nursed at home. This results in an unduly high case-fatality rate for

646 CASUALTIES AND MEDICAL STATISTICS

hospital cases. Also there may have been, at any rate in the past, a ten-
dency for the wealthier sections of the community to be treated in
nursing homes. Diseases showing a social class differential would,
therefore, not be represented in their true proportions in hospital
statistics. Conditions of life in the Forces were such, however, that
the greater number of patients requiring treatment in bed for more than
four days had to be sent to hospital; hence Service cases were more
representative of varying degrees of severity.

It may be urged that the population from which the E.M.S. hospital
cases were mainly drawn was a specially selected one, because those
with certain chronic diseases would be excluded by the Medical Boards
from entry to the Services at all. The methods of modern warfare,
requiring a relatively large number of technicians, are such that it was
not quite so essential to have all Service men of as high a standard of
fitness as in previous wars, while reserved occupations had to retain a
large number of those fit for service.

Most hospital statistics which have been presented in the past have
been based on serial observations made over a number of years in a
particular hospital. While the limitations of the E.M.S. data are fully
appreciated it is considered useful to produce an analysis of the results
obtained, firstly, because any conclusions which may be drawn are based
on a larger number of cases than has been available to individual
workers, secondly, because there has been a serious lack of knowledge of
such matters as duration of hospitalisation both for sickness and in-
juries, and lastly, because information is available about conditions such
as homologous serum jaundice, which the war brought into prominence.

THE EMERGENCY MEDICAL SERVICES 647

PART I. Service Patients
CAUSES OF ADMISSION

In all, the records of 317,699 patients admitted during 1940-47 were
examined, the constitution of the sample by sex and branch of Service
being as follows:

Army Navy Air Force Totals
Males 234,809 13,313 40,465 288,587
Females 18,388 994 9,730 29,112

The numbers of males admitted were 12-8, 13-4 and 4:2 times those of
females for the Army, Navy and Air Force respectively. The composi-
tion of the sample by sex and age is shown below.

15- 25- 35- 45- 55- All Ages
Males:
Numbers 115,917 | 120,415 45,643 5,964 648 | 288,587
Proportions 402 417 158 21 2 1,000
Females:
Numbers 22,048 5,720 1,147 191 6 29,112
Proportions 757 197 39 7 ° 1,000

Whereas the population of the country at large varies continuously, so
that it is possible to make a reasonably reliable estimate of its composi-
tion at intercensal periods, the number of Armed Forces at home was
subject to sudden fluctuations, making it impossible to calculate a popu-
lation at risk on which sickness rates could be based. The problem of
calculating rates would be further complicated by the admission to
E.M.S. Hospitals of cases returning from overseas theatres of war, and
in the later years of sick ex-prisoners-of-war. While it seems probable
that the number of Service cases treated in Military Hospitals was
about double that in E.M.S. Hospitals, it is by no means certain that
individual diseases were represented in the same proportions in the
two types of institution; this applies particularly to venereal diseases
which were mainly treated in Military Hospitals. For these reasons it has
been judged best to present proportionate rates. Since the incidence
of infective and respiratory diseases is subject to variation from year
to year, while the number of injuries depend very much on vary-
ing external factors, the proportions have been based in each year on
the total hospital admissions due to diseases not included in the ‘infec-
tive’ and ‘respiratory’ sections of the classification. For convenience in
presentation the diagnoses of primary causes of admission have been
condensed into a Short List of forty-two groups, the composition of
which in terms of code numbers of the Medical Research Council’s
Classification, is as follows:

648 CASUALTIES AND MEDICAL STATISTICS

S.L. M.R.C, M.R.C.
1 02, 03 60, 61
2 | 04,05 56-59
3 | 970-073, 443 620, 650
4 621-646, 651-679
5 00, o1, 06, 076— 68, 69
095, 097, 098 71, 72
6 10, 73-75
7 11-20 76 (except 7686)
8 22 , 840
9 270-274 841-845
10 21, 23-26, 275- 90-92
299 93
1 331-333 801-839, 846-898
12 51
13 30, 32, 330, 34,
35
14 36
15 37
16 3 544-554

The names of diseases in the groups have now been put in under each
section, for example, S.L.1. 02,03 Tuberculosis.

The non-infective and non-respiratory disease total on which pro-
portions are based consistsof Sections I-XI of the Abridged Classification
in Table I of Nos. 6-18; 22-37, in the Short List.

Annual tabulations according to the forty-two Short List numbers,
subdivided by ten yearly age groups for each sex are given in Appendix
I, page 724. The principal causes of admission for each year at all ages
are shown in Table 1.

The rheumatic diseases accounted for between one-twentieth and
one-twenty-fifth of the basic total of admissions of male patients and
a rather lower proportion of those of women. It was to be expected
that, owing to exposure to unfavourable weather conditions, Service
men would be more prone to rheumatic diseases than women, while at
the same time the nature of their work would make it less possible
for them to carry on their duties when suffering from such complaints.

The group of illnesses comprising psychoneuroses, functional
digestive disorders, psychoses and other nervous diseases contributed
their highest proportions in 1944 and 1945 among men, coinciding with
the campaign in Western Europe. It may well be that to many with a
neurotic disposition this was the precipitating factor. The proportionate
rate for women was highest in 1944, while for both sexes the rates were
comparatively low in 1943 and declined after 1945.

Eye and ear diseases showed fairly constant rates, varying for men
between 3 per cent. and 5 per cent. of the basic total and for women
between about 2} per cent. and 34 per cent. The rates for diseases of the

649

THE EMERGENCY MEDICAL SERVICES

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650 CASUALTIES AND MEDICAL STATISTICS

veins were much higher for men than women, and this may be com-
pared with the fact that in the Social Survey of Sickness enquiry in
1949, I per cent. of men and 6 per cent. of women between the ages of
16 and 64 interviewed, reported diseases of the veins. It is possible
that the higher proportion of male admissions attributed to vein
diseases may have been due to the active conditions of service neces-
sitating treatment with which it had been possible to dispense in civilian
life, while for aesthetic reasons women would be more likely to seek
early treatment for such a condition as varicose veins.

Acute sore throat, which comprises acute tonsillitis and acute pharyn-
gitis, showed high proportions in 1940. During the subsequent years
both sexes followed the same trend, showing decline in 1941 and 1942, an
increase in 1943, further decreases in 1944 and 1945 and a rise in 1946.
The proportionate rates varied among men between 6 per cent. and 10
per cent. and between 6 per cent. and 15 per cent. among women.
Hernia accounted for comparatively few of the women’s admissions,
while for men the rates were only a little less than those for diseases of
the veins.

Gastric and duodenal ulcers showed relatively high proportions in
1945 and 1946 for both sexes. From 1942 to 1947 the men’s rates
showed a similar trend to that for nervous diseases; declining from 1942
to 1943, rising to a maximum in 1945, then declining again in 1946 and
1947. This similarity is understandable in view of the psychoneurotic
underlay in ulcer cases. The high proportion of women’s admissions
attributed to other digestive diseases is due to a large number of cases of
appendicitis. Both sexes show high proportions of admissions due to
skin diseases, 15-19 per cent. of the basic total for men and g-11 per cent.
for women. It is possible that this may be due to some extent to the
transmission of such diseases as impetigo or sycosis barbae. Among
males, admissions for diseases of bones, joints and muscles included a
considerable number attributable to internal derangement of the knee
joint, often due to physical training or organised games. Of the remaining
non-infective and non-respiratory causes, the higher proportions for
women were due to child-bearing and diseases of the female genital
organs, the proportions in the eight years due to these causes being
14°3, 14°1, 14°0, 13-9, 19°0, 19°3,16-4 and 22-2 per cent.

The proportions of admissions due to the conditions classed as
infective diseases were highest for both males and females in 1940. For
men the rate decreased in 1941 and 1942, and then increased, while for
women there was a steady decline up to 1945, after which the rate again
increased. Venereal diseases in every year had proportionate rates of less
than 1 per cent. The rate for respiratory conditions remained fairly
steady for men, while for women it declined between 1941 and 1945.
The proportionate rates for injuries of all kinds depended to a large

THE EMERGENCY MEDICAL SERVICES 651

extent on the number of war injuries. In 1940, the year of the Dunkirk
evacuation, the rate was 296 admissions for injury to every 1,000 admis-
sions for non-infective and non-respiratory diseases and declined to 246
in 1941; this was followed by an increase in 1942 and 1943, reaching the
peak value of 659 in 1944, with the opening of the Western front.

Selected Causes of Admission by Disease Group

TUBERCULOSIS (Short List Number 1)

The ratios of the numbers of admissions for all forms of Tuberculosis
to 1,000 admissions for non-infective and non-respiratory illnesses in the
corresponding sex-age groups were as follows:

TABLE 2

Tuberculosis, all forms. Proportion per 1,000 Admissions for Non-infective and Non-
respiratory Illnesses, by Sex and Age, 1940-47

Males Females

Year

1940
1941
1942
1943
1944
1945
1946
1947

Among men, from 1941-45, tuberculosis cases showed a greater
ratio to the basic total of causes of admission at ages 15-24 than at any
other age. Subject to yearly variations, there was a generalised upward
trend in the rates over the eight years at ages 15-44. Since those who
showed signs of tuberculosis at their medical examination would have
been excluded, there would be a lag between entering the Forces and
developing a disease like tuberculosis, and hence an increase in the rate
with time is to be expected. The rates for women do not show the same
trend, but as they were based on small numbers, particularly during the
earlier years, it is inadvisable to attach too much importance to them.
It is possible that the increased tendency towards tuberculosis among
men may have been partly aggravated by exposure to adverse weather,
lack of drying facilities for wet clothes, or being of necessity crowded
together on the lower decks of troopships, conditions which would not
apply to women, while the retention in the Services of those with chronic
disease during the demobilisation of 1946-47 and also the severe
winter of 1947 would have contributed to the high rates in those years.

652 CASUALTIES AND MEDICAL STATISTICS

Many young women at the susceptible ages would have been leading
much healthier lives, with more fresh air and exercise, a better diet and
more regular hours than they would have led in civilian life.

TABLE 3
Ratio of Number of Admissions for Respiratory Tuberculosis to that for Other Forms

Males Females

Year Age groups Age groups

15- 25- 35 up All 15- 25 up All
1940 29 3tr 77 3°5 2-0 1's 7
1941 21 3°3 7°83 29 2-7 o's 18
1942 3°5 41 71 41 "7 2°3 19
1943 4°4 3°3 5°7 4°1 2°5 18 24
1944 40 44 13°8 4°7 26 "9 2°70
1945 3°3 5°7 6-2 4°6 27 21 2°5
1946 4°4 9°3 18:0 6-4 12 5°0 18
1947 6-4 19°0 * 8-8 ro 10 10

* Indeterminate

The ratio of the number of cases of respiratory tuberculosis (M.R.C.
code numbers 020-029) to that of non-respiratory (030-039) increased
for men of all ages from 2-9 in 1941 to 8-8 in 1947. This was primarily
due to an increase in pulmonary tuberculosis and pleural tuberculosis
with effusion, the former being over three times as frequent in 1944 as
in 1940. The commonest sites of non-respiratory tuberculosis among both
men and women were the lymphatic and genito-urinary systems.
Cases of pleural tuberculosis with effusion for both sexes and all ages
were 30 times as numerous as those without mention of effusion. This
may be contrasted with pleurisy described as non-tuberculous, in which
the proportion of cases with effusion to those without was 0-58. This
supports the view that cases of pleurisy with effusion are more likely
than not to be tuberculous, and in the International Statistical Classifica-
tion of Diseases, Injuries and Causes of Death (1948) pleurisy with
effusion without mention of cause is included in the group ‘Pleural
tuberculosis’.

Since a follow-up of tuberculosis cases after discharge from the Army
was impracticable, it has not been possible to obtain accurate case-
fatality rates. The following rates are based on such deaths as were
known to have occurred, and therefore, particularly for some forms of
respiratory tuberculosis, they are under-estimated.

The fatality rate for tuberculosis of the vertebral column was more
than six times that for other bones and joints. A high case-fatality rate,
95 per cent., was recorded for tuberculosis of the meninges, but the
introduction of streptomycin will have reduced by now the death rate

THE EMERGENCY MEDICAL SERVICES 653

TABLE 4
Case-fatality Rates for certain forms of Tuberculosis, 1940-47

M.R.C. Recorded | Fatality
Code Diagnoses Cases Deaths Rate
No. per cent.
0210 =| Pleural Tuberculosis with effusion . $ 418 12 2°6
0220 | Miliary Tuberculosis lungs; no evidence
of generalised miliary Tuberculosis . 32 22 68-8
0221 | Pulmonary Tuberculosis, bacilli sought
but not found . 817 14 7
0225 Pulmonary Tuberculosis, Ungraded, but
bacilli found. 1,757 130 714
0226 | Pulmonary Tuberculosis, unqualified as to
presence or absence of bacilli. 257 12 4°7

023 Miliary Tuberculosis lungs, with
evidence of senerelised miliary

Tuberculosis . ‘ < 15 8 53°3
030 | Tuberculosis, meninges and central
nervous system . 42 40 95°2
031 on intestines and peritoneum
(including mesenteric
lymph nodes) ss 5 108 9 8-3
032 } vertebral column . 3 92 5 5°4
033 a other bones and joints 2 118 1 o'8
035 a lymphatic system. ij . 235 ° _
036 ” genito-urinary system 5 196 3 15

from this disease. Most of the 40 deaths occurred within three weeks of
admission to hospital, the median period between admission and death
being 11 days. The distribution is shown below.

Tuberculosis of the Meninges and Central Nervous System. Period between
Admission and Death

sod eg eg eae ae te

These deaths do not include cases of respiratory tuberculosis complicated
by tuberculous meningitis in which the latter was probably the
terminal cause of death.

In 121 cases, tuberculosis of more than one site was recorded. The
frequencies with which such combinations occurred is shown below,
without regard to the order in which the sites were affected.

Tuberculosis of lungs and trachea with

Pulmonary tuberculosis . : ‘ % : . 16 cases
Pleural tuberculosis with

Pulmonary tuberculosis . : e 3 . easy Mea

T-.B. of meninges and C.N.S. . . 2 f LY aN

» » intestines and peritoneum. ‘ “ ee Ry

654 CASUALTIES AND MEDICAL STATISTICS

»» 9, lymphatic system. 7 ; ‘ 4 ‘ I

9» genito-urinary yee é ‘ S : ee |
» », Other sites . 5 ‘ A . ae ¢

Pulmonary tuberculosis with
Miliary T.B. of lungs and evidence of aaa miliary 1

T-.B. of meninges and C.N.S. . : . - 4
»» »» intestines and peritoneum. z - _ 7
» »» vertebral column . ‘ - . » 5
+» », Other bones and joints : - < 2 19
» », Skin . ss i ‘ ‘ . . wo, OE

1» 9» lymphatic system. G A ‘ . 8
1» 9» genito-urinary system . é 2 ¥ . 8
»» other sites . . : ‘ 3 a |
Other disseminated tuberculosis 2

Miliary T.B. of the lungs and evidence of pices gist) hi
T.B. of meninges and C.N.S.
»» 9 intestines and peritoneum. : : ces
» », Other sites . . ? 3 ' Cas |

Radiological evidence of T.B. lungs with
T-.B. of lymphatic system. ; . fi 5 ves

T-.B. of meninges and C.N.S. with
Other disseminated T.B. . : : : . a 92

T.B. of intestines and peritoneum with
T.B. of lymphatic system.
Acute generalised miliary tuberculosis

~~

T.B. of vertebral column with
T.B. of other bones and joints
+» 9» lymphatic system.
»» 99 genito-urinary system .
Acute generalised miliary T.B. .

T.B. of other bones and joints with
T.B. of lymphatic system. . 5 : fs 4 ek
+» 9» genito-urinary system . ’ . ‘ ‘ I

oom)

In five cases out of every 1,000 with tuberculosis there was mention
of pleural effusion which was not described as tuberculous. Gastric or
duodenal ulcer was concurrent with tuberculosis in 3 cases per 1,000
and perirectal abscess in 2 per 1,000. In only one case was there mention

of diabetes.

THE EMERGENCY MEDICAL SERVICES 655

VENEREAL DISEASES (Short List Number 2)

Table 5 shows the ratio of admissions for venereal diseases per 1,000
non-infective and non-respiratory illnesses. There is little sex-age
variation, probably due to only a small proportion of cases of venereal
diseases being treated in E.MLS. hospitals.

TABLE 5

Venereal Diseases. Ratio per 1,000 Admissions for Non-infective and Non-respiratory
Illnesses, 1940-47

Males Females
Year Age groups Age groups
15- | 25- | 35- | 45- | 55 up| All ages | 15- | 25—

35- | 45 up| All Ages
1940 | 6 2 5 14 12 5 8 }—|J— -_ 6
1941 | 8 6 7 | 15 = 7 8 an Pi = 7
1942] 4 4 5 6 = 4 4 4)/— 37 4
1943] 3 | 3 | 3 | 9 | 33 3 3 5 {16 | — 4
19441 3] 31 4] 5 13 3 CE EOE: eset (ees 3
194s] 2] 3] 4) 9) — 3 2 iene ees 2
1946 | 2 5 5 8 a 4 3 COD lected tee 3
1947] 2 | © }— |— | — 2 Se forte 4

For 1943, the percentages of cases of gonorrhoea and syphilis among
100 sick military personnel treated in hospitals in the United Kingdom
were 5:3 and 1-2 respectively. (Statistical Report on the Health of the
Army, 1943-45, H.M.S.O., 1948.) The number of men treated in
Military Hospitals for gonorrhoea was 55 times that in E.M.S. hospitals,
and for syphilis, including toxic jaundice, 33 times.

TABLE 6

Venereal Diseases. Proportionate Age Distribution of Admissions. Males.
1940-47.

Age Groups
Disease Group

1s- | 25- | 35- | 45- |55 up | All Ages
040-049 | Syphilis and its sequelae. | 296 | 328 | 247 115 14 1,000
50-057 | Gonorrhoea and other

venereal diseases . | 423 416 144 17 _ 1,000

It may be seen from Table 6 that cases of syphilis were spread fairly
evenly over the age groups under 45, whereas gonorrhoea was more
frequent in those under 35. This may be due to appearance of delayed
manifestations of syphilis at older ages among those who had not been
completely cured. The number of cases of congenital, primary and secon-
dary syphilis in men under 35 was 5-1 times the number in men of 35

656 CASUALTIES AND MEDICAL STATISTICS

and over, while cases of cardio-vascular syphilis (including aneurysm of
the aorta) locomotor ataxia, general paralysis of the insane and other
forms of neurosyphilis were 2-8 times the number in those over 35.

INFLUENZA, COLDS AND LARYNGITIS (Short List Number 3)

These three diseases made a considerable contribution to the causes
of admission to hospital, especially during 1940 and 1943, as appears
from Table 7.

‘TABLE 7

Colds, Influenza and Laryngitis. Ratio per 1,000 Admissions for Non-
infective and Non-respiratory Illnesses, 1940-47

Females

Year Age Groups

15- 35-
1940 | 277 274
1941 | 110 49
1942 57
1943 | 112 122
1944 st 33
1945 36 8
1946 38
1947 | 61 xe

The proportion among men at ages 15-24 was higher in every year
than at ages 25-34, while this age-group in turn had higher rates from
1940-46 than the age-group 35-44. No such definite pattern was
shown by rates for women. Very few cases of laryngitis were recorded,
and since, for cases admitted to hospital, it would be difficult to distin-
guish clearly between those diagnosed as influenza and those described
as common cold, the following tables have been compiled by com-
bining figures for influenza and colds.

TAsLe 8

Colds and Influenza. Highest number of weekly admissions and five-weekly
averages about the peak week. Persons. 1940-44

lof admis-
sions

THE EMERGENCY MEDICAL SERVICES 657

Table 8 shows the numbers of cases admitted for the two conditions
during the ‘epidemic’ periods of the winters of 1940-44; from 1945-47
the figures showed very little variation from week to week. It will
be noted that whereas the peak of the epidemic is usually reached after
Christmas, in the winter of 1943-44 the maximum number of weekly
admissions occurred during late November. A comparison with Table 9,
which gives the numbers of weekly deaths assigned to influenza in 126
Great Towns of England and Wales, shows that in 1943-44 the
maximum number of weekly deaths also occurred before Christmas.
(Registrar General’s Weekly Return of Births, Deaths and Infectious
Diseases.)

TABLE 9

Influenza. Highest number of weekly deaths in 126 Great Towns, and five-weekly
averages about the peak week, 1940-44

Highest weekly Five-weekly averages of deaths about
deaths peak wee!
Year 8-12 [3-7 weeks] 2 weeks 3-7 8-12
Week Number | weeks fe before weeks weeks
ending | of deaths} before -2 weeks | after after
peak after peak peak
1940 | Feb. 24. 629 29 521 165 36
1941 Feb. 15. 324 31 268 121 39
1942 | Jan. 31 . ge 30 77 69 32
1943 Feb. 13. 131 31 I 68 22
1943 Dec. 11. | 1,148 12 809 233 52

There was a less well-marked epidemic period in 1942 than in the other
years, both as regards hospital admissions and the deaths in the Great
Towns. If curves were drawn for the five-weekly averages shown in
Table 8, there would be a skewness of the curve with extension of the
descending limb for each year except 1942, and the same trend is
apparent for the deaths in Table g for the years 1941, 1942 and 1943.

Table 10 shows the distribution of days of in-patient treatment for
influenza and for colds; cases in which there was a record of any
concurrent disease or injury have been excluded from this table. For
influenza, the median period of treatment in hospital for men aged
15-34 and 35-54 was 11 days, while for women aged 15-34 it was 9
days; for colds the median period was 1o days for men in each age
group, compared with 8 days for women. That in 1942 the median
period was 12 days for men in both age groups may be attributed to the
decreased demands on hospital accommodation consequent on the
smaller number of cases occurring in thatyear. The longer durations may
be due to defective reporting, the cause of admission only being stated
in the case notes, without mention of an accessory disease or complica-
tion, or they may be due to cases of post-influenzal debility, which

658 CASUALTIES AND MEDICAL STATISTICS

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660 CASUALTIES AND MEDICAL STATISTICS

would be coded to the same number as influenza, but would probably
require a longer period in hospital.

The disruption caused by influenza and common colds is indicated
by the fact that for the men in the 15-34 age group, whose hospital
experience is shown in Table 10 during 1940, 2,808 were in hospital
with influenza for a total of 37,766 days, an average of 13-4 days per
man, while 253 were in for 2,969 days, an average of 11-7 days, with
common colds. Corresponding figures for 1941 were, for influenza,
1,433 men for 18,723 days, average 13-1 days and for colds, 334 men
for 4,283 days, average 12-8 days.

SCABIES (Short List Number 4)

Scabies, the mite of which is readily transferred by contact or on
clothing where people are crowded together, might well become a
problem among non-civilian personnel.

TABLE 11

Scabies. Ratio per 1,000 Admissions for Non-infective and Non-respiratory
Ilinesses, by Sex and Age, 1940-47

Table 11 shows that among men the ratio of admissions for scabies
per 1,000 basic admissions declined from 50 in 1940 to 14 in 1942, then
varied for the remaining years between 3 and 7, while among women it
declined from the high levels of 123 and 139 in 1940 and 1941 respec-
tively to 11 in 1943, afterwards varying between 2 and 4. It is possible
that the high rates in the early years of the war were due to people
who had brought the infection into the Forces from civilian life, but that
once these people had been freed from infestation there was little spread
of the disease.

The median period of in-patient treatment for men aged 15-34
varied from year to year between 8 and 11 days; taken over the seven
years 1940 to 1946 it was 10 days for this age group and also for men

66r

THE EMERGENCY MEDICAL SERVICES

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662 CASUALTIES AND MEDICAL STATISTICS

aged 35-54. The median number of days for women aged 15-34 taken
over the seven years was 8. Examination of the numbers of weekly
admissions did not show any marked seasonal variation.

OTHER INFECTIVE DISEASES (Short List Group 5)

The group contains, among others, malaria, dysentery, the common
infections usually associated with childhood, Vincent’s angina and
ringworm. From 1940-44 the rates for men under 55 decreased with
age, this trend being disturbed during 1945-47 by the influx of
large numbers of malaria cases (Table 13). A similar trend was shown

TABLE 13

Other Infective Diseases (Short List Number 5)*. Ratio per 1,000 Admissions
Sor Non-infective and Non-respiratory Illnesses, by Sex and Age, 1940-47

Males Females

Age Groups Age Groups
35- | 45-|ssup| All | r5-

25] 23] 55 67 | 106 96
31 2r _ 65 91 g1
38 | 23 | 48 | 75 98 91
99 68 13 150 110 103
87] 43 | 32 | 148 | or 83

83 | — | 169 4

* See p. 648 for the composition of this group of diseases.

by women’s rates in 1941, 1944, 1945 and 1947. The rates for men and
women at all ages were high in 1940, chiefly owing to an increased inci-
dence of rubella in that year, while the high rate for women at all ages
in 1944 is attributable to the same cause. Table 14 shows the pro-
portionate composition of admissions assigned to Short List Number 5.

Admissions for malaria, which in the one-in-five sample had been less
than 100 annually during 1940-42, increased suddenly in 1944, but
declined again by the second half of 1946. The numbers recorded during
the ten quarters from January 1944-July 1946 with a primary diagnosis
of either benign tertian malaria (M.R.C. No. oogo) or ‘other and un-
specified malaria’ (0094) were as follows:

M.R.C,
Code

1944 1945 1946
Qx | d | Qs | a4 | ax | @2 [a3 | O4 | Qx

e090 | Benign tertian malaria | 213 | 873 | 466 | 234 | 245 | 289 | 224] 335 | 265| 87
0094 | Other and unspecified
malaria 4 .

129 | 409 | 326] 135 | 163} 214] 180] 223] 156] 49

663

THE EMERGENCY MEDICAL SERVICES

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664 CASUALTIES AND MEDICAL STATISTICS

The estimated total admissions for all forms of malaria in these ten
quarters was about 26,000. Of all admissions for malaria during the
eight years under review, 49 per cent. occurred in 1944, 33 per cent. in
1945 and 11 per cent. in 1946.

Rubella contributed largely to the admissions for infective diseases of
both sexes, a total of 2,388 cases being recorded in the sample, which
corresponds to about 12,000 admissions to E.M.S. hospitals altogether.
The rate was high for both sexes in 1940 and for women in 1944. A
well-marked epidemic trend in weekly admissions was apparent in 1940
and a less pronounced one in 1944 (See Table 15).

TABLE 15

Rubella. Highest number of weekly admissions and three-weekly averages
about the peak week. Persons, 1940 and 1944

Highest weekly Three-weekly averages of admissions about
peak week

admissions

It will be noticed that the curve for three-weekly averages in 1940
shows a skewness similar to that for influenza admissions in that year.

RHEUMATIC DISEASES (Short List Group 6)

This group includes acute rheumatic fever, arthritis and rheumatism.
Table 16 shows that of all admissions for rheumatic diseases during
1940-47, rheumatic fever accounted for a little under one-fifth for

TABLE 16
Proportionate Composition of Admissions for Rheumatic Diseases, by Sex,
1940-47

100 Acute rheumatic fever . g
Joo Rheumatoid arthritis 7
793 i a3"
701-2,

704-5 | Other forms of arthritis 5°
706 Fibrositis, rheumatism, etc. 8-

Totals

THE EMERGENCY MEDICAL SERVICES 665

men and rather more than one-fifth for women, while for each sex over
half were attributed to fibrositis and rheumatism. Further, while
between seven and nine times as many men as women were admitted for
rheumatic fever, rheumatoid arthritis and rheumatism, twenty-four
times as many were admitted for osteo-arthritis and sixteen times for
other forms of arthritis.

TABLE 17

Rheumatism, Arthritis and Fibrositis. Proportion per 1,000 Admissions
for Non-infective and Non-respiratory Illnesses, by Sex and Age, 1940-47

Males Females

Year Age Groups Age Groups

In Table 17 the proportion of admissions attributed to rheumatic
diseases per 1,000 non-infective and non-respiratory diseases are
shown. From 1940 to 1944 there is no striking annual variation in the
rates for men under 55 years of age, while in each year the rates increase
with age. At ages 15-24 rheumatic diseases caused less than 4 per cent.
of the basic admissions, at ages 25-34 less than 6 per cent., while at age
45 and over they accounted for up to 13 per cent. during 1940-44.
Among women the rates at ages 15-34 were considerably less than for
those aged 35 and over. Rheumatic fever is known to attack the young
rather than those older, while the numbers of deaths from chronic
rheumatism (including rheumatoid arthritis) are much higher after age
60 than before. It would appear, therefore, that whatever the actual
incidence of rheumatism and fibrositis, the disability caused increases
with age.

From Table 18 it is evident that both acute rheumatic fever and
muscular rheumatism showed seasonal trends, the admissions for acute
rheumatism being highest in either the first or second quarters and those
for other rheumatism usually in the first quarter or the fourth quarter
of the preceding year. Since there would appear to be a connexion
between the period of worst weather conditions and the incidence of
rheumatic disease, the question of the provision in workplaces of

666 CASUALTIES AND MEDICAL STATISTICS

‘Taste 18

Quarterly Admissions for Acute Rheumatic Fever (M.R.C. Code 100) and
Fibrositis, Muscular Rheumatism and Lumbago (M.R.C. Code 706)
Males, 1940-1945

M.R.C. Diseases Season 1943 | 1944 | 1945
Code

100 Acute rheumatic | 1st Qtr. 64 7 72

fever. . | 2nd Qtr. 52 87 97

3rd Qtr. 30 45 43

4th Qtr. 4. 58 36

706 Rheumatism, ist Qtr. 239 «| 219 138

fibrositis, etc. . | 2nd Qtr. 181 154 99

3rd Qtr. 171 149 86

4th Qtr. 195 168 65

facilities for drying clothes becomes pertinent to the problem of
preventing this type of disability. Figures from the Survey of Sickness
carried out among people aged sixteen and over show that for the period
May 1946 to April 1947, the monthly inception rate* for rheumatism
and other diseases in M.R.C. Code 706 was 5,301 per 100,000 and the
prevalence ratet 16,055 per 100,000. Hence about 1 person out of 19
developed an attack of rheumatism during the average month, while
including attacks which began previously, 1 person out of 6 reported
suffering from rheumatism at some time during the month. Even where
these attacks do not cause absence from work, it is possible that there is
a lowering of production efficiency.

For cases in which there was no record of any concurrent disease,
the median number of days of in-patient treatment for rheumatism
varied between 15 and 20 days for men aged 15-34 and between 19 and
24 days for those aged 35-54. Taken over the seven years 1940-46
the medians were 20 days and 21 days in these two age groups. For
women aged 15-34 the median period was about 18 days. The average
period of treatment over the years 1942 and 1943 was 37 days for men
aged 15-34 and 35 days for those aged 35-54.

In view of the question whether or not rheumatic fever was associated
in any way with infection by haemolytic streptococci, 421 case histories
of rheumatic fever were examined in detail for mention of scarlet fever,
erysipelas, otitis media, streptococcal sore throat and other infections
specified as streptococcal. These cases were not selected by any rule,
but were the first ones to come to hand. The diagnoses of the 421 cases
were as follows:

* Number of diseases beginning in the month, per stated number of people.
+ Number of illnesses present in the population at any time during the month,
regardless of when they began, per stated number of people.

667

THE EMERGENCY MEDICAL SERVICES

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668 CASUALTIES AND MEDICAL STATISTICS

Acute rheumatism. 171 41 per cent.
Sub-acute rheumatism —112 26 per cent.
Rheumatic fever “ 105 25 per cent.
Rheumatic carditis . 17 4 per cent.
Others . ‘ : 16 4 per cent.

Totals . E 421 100 per cent

Mention of an attack of scarlet fever was found in 25 cases (5-9 per
cent.) and of the presence of streptococci in the throat in 8 cases or
1-9 per cent. Six histories recorded suppurative otitis media and another
10 such conditions as otitis externa or discharging ears. There was no
mention of erysipelas. At least one previous attack of acute rheumatism
had occurred in 28 per cent. of the cases. The intervals elapsing between
the present attack of rheumatic fever and the preceding one, and between
attacks of scarlet fever and subsequent rheumatic fever are shown in
Table 20.

TABLE 20

Interval between two attacks of Rheumatic Fever and between attacks of
Scarlet Fever and Rheumatic Fever in a sample of 421 cases

Interval in Years

Under} 1-4 | 5-9 | 10-14] 15-19 |20 and! Not |Totals
1 over | stated

Rheumatic fever; present
attack and preceding
one. . : 4 9 25 34 26 11 8 3 116

Scarlet fever and first
attack of rheumatic
fever . z . 6

Scarlet fever and present
attack of rheumatic
fever . : 3 . 2

a
+
“
a
y
w

w
w
w
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»
a
»
a

The condition of the throat was recorded in 64 per cent. of the cases
and in 65 cases (15 per cent.) was stated to be healthy. In some cases
rheumatic fever had been very shortly preceded by tonsillitis. There was
a past history of sore throats or tonsillitis in 7 per cent. of the cases. In
many cases dental sepsis was noted, thus showing the presence of another
form of septic focus. The frequency of occurrence of adverse throat
conditions is shown in Table 21.

NEOPLASMS, DIABETES, ANAEMIAS AND OTHER GENERAL AND
ENDOCRINE DISEASES (Short List Numbers 7-10)

Admissions for these diseases formed a relatively small proportion of
the basic total, and except in the case of neoplasms there was very little

THE EMERGENCY MEDICAL SERVICES _ 669

‘TABLE 21

Cases of Rheumatic Fever (M.R.C. Code 100) associated with a throat
condition (Sample of 421 cases)

Throat Condition Acute {Rheumatic} Sub-acute /Rheumatic|Others
Rheumatism] Fever |Rheumatism| Carditis

Sore throat immediately

preceding attack. 34 ar 20 6 2
Throat of unhealthy

appearance 4 5 3 - 1
Past history of sore throats 3 3 7 _ -
Tonsillitis immediately

preceding attack. 16 8 7 1 I
Tonsils of unhealthy

appearance 1 8 6 1 _
Past history of tonsillitis 9 3 6 _ _
Sore throat and tonsillitis

preceding attack. 2 2 1 a
Both throat and tonsils

unhealthy 3 2 _ 1 _
‘Throatstated | to be healthy 31 14 17 2 1

variation from year to year. For neoplasms the rates for males showed a
general upward trend at all ages and in the three ten-yearly age groups

TABLE 22

Neoplasms. Proportion per 1,000 Admissions for Non-infective and
Non-respiratory Illnesses, by Sex and Age, 1940-47

Females
Age Groups
25- | 25-44 | All Ages

Year

1940 eR 59 15
1941 24 86 27
1942 38 48 28
1943 42 ur 30
1944 40 61 32
1945 44 24 35
1946 Jo 192 5°
1947 30 500 24

under 45. The rates for females also showed a tendency to increase
between 1940 and 1946. The ratio of non-malignant neoplasms and
those of unspecified nature to those stated to be malignant was as
follows:

Ages 15- -25- 35- 45- 55 up All ages
Males 74 41 1°5 o7 0°24 3°70
Females = 27°7,—12°9.— 143 3 indeterminate 18-1

670 CASUALTIES AND MEDICAL STATISTICS

The most frequently occurring non-malignant neoplasms were those
of the skin, bones and cartilage and nasal polyps.

Of the general diseases in Short List Number 10, 39 per cent.of men’s
admissions were due to lymphadenitis and lymphangitis, 32 per cent. to
asthma, 5 per cent. to urticaria and 54 per cent. to simple and ex-
ophthalmic goitre. Taken over the seven years 1940-46, the median
period of in-patient treatment for asthma among men aged 15-34 was
21 days, among those aged 35-54, 25 days and for women aged 15-34,

17 days.

TABLE 23

Asthma (211). Periods of In-patient Treatment of cases in which no other
pathological condition was recorded, 1940-46

Days of In-patient Treatment

Sex Median

oo] 7 [r0- 14- | 21—| 28- | 35- | 42-| 56- | g1- | 182- | Total | duration

Males 60 | 75 | 98 |1s8 | 77 | 63 | so | 79 | 93 | 38 1 | 80x | 21 days
Males yo | 22 | 17 | $9 | 33 | 31 | 22 | 24 | 27 9 a 256 25 days

16 | 37 | 17 9] 12 9 T —- 159 17 days

* Adjusted for cases in which the complete period of treatment was not known.

DISEASES OF THE NERVOUS SYSTEM (M.R.C. 30-35) AND
FUCTIONAL DISORDERS OF THE STOMACH AND INTESTINES
(M.R.C. 51) (Short List Numbers 11-13; 16)

The contribution of these diseases to the basic total of causes of
admission varied between 10 and 15 per cent.

TABLE 24

Psychoneuroses. Proportion 1,000 Admissions for Non-infective
and Non-respiratory Illnesses, by Sex and Age, 1940-47

Males Females

Year Age Groups Age Groups

15- | 25- | 35- | 45- | ss up| All | 15- | 25- | 35- | 45- | 5s up| All

1940} 41 | 46 | 71 | 58 | 35 47 | 30 8 | 39] — |] — | 26
1941 | 42 | 51 | 68 | 52 18 50 | 37 | 54 | 37 | 168 _- 41
1942 | 58 | 67 | 71 | 65 14 | 65 | 33 | 83 | 73 | — |] — | 43
1943 | 54 | 71 | 80 | 44 |] 16 | 66 | 47 | 48 | 58 | 65 | — | 47
1944 | 73 | 92 | 73 | 63 | 13 | 8 | 58 | 83 | 67 | —] — | 63
1945 | 82 |119 | 66 | 46 | 32 | 94] 54 | 65 | 79 | — | — | 88
1946 | 70 | 71 | 79 | 28 | — | 7x | 18 | 13 | 77 | — | — | 38
1947} 48 | 34 | 21 | 45 | — | 44] 34 | —] —|] —] — | 29

Among men at ages 15-34, the rates for psychoneuroses were highest
in 1944 and 1945, coinciding with the opening of the Second Front in
Europe, and they were higher than those for men aged 35 and over.

THE EMERGENCY. MEDICAL SERVICES 671

Many of the older men would have gone through the North African
campaign, with a resultant weeding out of psychiatric casualties
attributable to the fighting in that theatre of war. For women aged 15-24,
the rates were also highest in 1944 and 1945. Rates were higher at ages
25-34 than at 15-24, for men in each year from 1940-46 and for
women from 1941-45.

TABLE 25

Functional Digestive Disorders. Proportion per 1,000 Admissions for Non-
infective and Non-respiratory Illnesses, by Sex and Age, 1940-47.

Males Females

Year Age Groups Age Groups

t5s- | 25- | 35- | 45- | ss- | All | r5- | 25~ | 35- | 45- | ss- | All
1940 | 13 | 17 | 31 | 22 47 17 | 25 | 42 | 20 | — | — | 28
1941 | 19 | 28 | 36 | 33 | 55 | 26 | 29 | 19 | 37 | — | — | 27
1942 | 22 31 34 | 21 _ 28 | 30 25 18 | 74 _ 29
1943 | 18 | 22 | 31 17 _ 22 | 23 | 23 si{— = 22
1944 | 13 | 20 | 25 | 31 13 1 | 19 | | —|—]{ — 17
1945 | 17 22 | 26 18 32 21 20 bo 8] — _ 7
1946 | 11 14 1 _ _ 12 18 | 25 —-|j- _ 18
1947 | 13 | 15 | —| —| — | 3] 1] —}| —| —]| -— | 2

Of admissions for functional digestive disorders (M.R.C. Code 51)
among men, 78:8 per cent. were for functional dyspepsia, 16-7 per cent.
for constipation and 2-4 per cent. for spastic colon; the corresponding
rates for women being 29-9 per cent., 64-9 per cent. and 3-1 per cent.
Table 25 shows that,among men, from 1940 to 1945 proportionate
rates increased with age between 15 and 44, while with the exception of
1943 the same is true for women aged 15-34.

TABLE 26

Psychoneuroses (Short List Number 11). Proportionate Frequencies in
certain Sex-Age Groups, 1940-47

le
331 Abnormal character
states BS 59
3320-3321 | Anxiety states 370
3322 Obsessional states. 7
3323 Reactive depression 132
3324 Hysteria 289
3330 Effort syndrome 12
3331-5, 7 | Psychoneuroses with 6
somatic symptoms
3336 Nocturnal
¢ ene 22
333 lypochondriasis . -
33390 Unspecified "
psychoneurosis .

672 CASUALTIES AND MEDICAL STATISTICS

Table 26 shows that, of the psychoneuroses for which men were
admitted to hospital, half were described as anxiety states and nearly a
quarter as hysteria, while for women nearly two-fifths were ascribed to
anxiety states and three-tenths to hysteria. The preponderanceof anxiety
states (including sexual perversion) made a greater contribution to the
among Service doctors. A higher proportion of women than of men
had a diagnosis of reactive depression, whereas abnormal character
states (including sexual perversion) made a greater contribution to the
men’s total of psychoneuroses, either due to a greater incidence or
because these conditions in the male are perhaps more likely to come
to light. Effort syndrome, which includes the condition known during
the First World War as soldier’s heart, had a comparatively small ratio.

TABLE 27

Psychoneuroses, etc. Proportionate Age Distribution of certain forms.
Males, 1940-47

Disease Groups

Abnormal character states .

331 1,000
3320-1 Anxiety states . 1,000
3322 Obsessional states 1,000
3323 Reactive depression . 1,000
3324 Hysteria . 1,000
3330 Effort syndrome 1,000
3336 Nocturnal enuresis. 1,000

Psychoneurosis unspecified 1,000
3331-3339 | All forms of neurosis 1,000
340-345 All forms of psychosis 1,000
5113 Functional dyspepsia 1,000

5122 Constipation

The proportionate age distributions among men of themorefrequently
occurring forms of neurosis are shown in Table 27, and are compared
with similar distributions for psychosis (all forms), functional dyspepsia
and constipation. Anxiety and obsessional states and reactive depression
appeared much more frequently at age 25-34 than at 15-24. Enuresis,
however, was much more frequent as a cause of treatment in those aged
15-24, as might be expected from its incidence in early life and the
circumstances of life in the Forces.

Psychoses of all forms were fairly evenly distributed over the two
decennial age-groups under 35, an excess of cases of schizophrenia
occurring at ages 15-24. Functional dyspepsia showed a distribution very
similar to that for reactive depression, while constipation was more
frequent as a reason for treatment at ages 15-24.

THE EMERGENCY MEDICAL SERVICES 673

Of the remaining diseases of the nervous system, the most common
was sciatica, a total of 1,658 males and 70 females in the sample having
been admitted for this cause during 1940-47, corresponding to around
8,300 actual admissions for men and about 350 for women. The age
distribution was as follows:

Ages 15-25-35 45-55 up Alll ages
Males 251 783 542 79 3 1,658
Females 36 32 2 _ _ 70

The possible association of sciatica (M.R.C. 323) with a prolapsed
intervertebral disc (M.R.C. 726) is one which has come to be increasingly
recognised during the last few years. The record cards were examined
for cases in which sciatica was stated to be the primary cause of
admission, but in which a prolapsed disc was also mentioned, also for
those in which a prolapsed disc was given as the primary cause but with
mention of sciatica. The results are shown in Table 28 below:

TABLE 28

Association of Sciatica (323) with Prolapsed Intervertebral Disc (726)
Males, aged 15-54.

Primary Code 323 Primary Code 726 Primary Code 323 or 726
Year | Totals| With | Percent- | Totals| With | Percent- | Totals i Percent-
mention | age with mention | age with 323 and | age with
of 726 726 of 323 323 726 323 and
726
Males aged 15-34
1940 123 2 16 1 ° ° 124 16
1941 170 1 06 I ° ° 172 06
1942 192 2 re 18 7 38:2 210 43
1943 1 4 24 22 7 3r 189 s
1944 171 12 70 22 2 40°9 193 109
194: 158 23 14°6 45 17° 203 15:3
tyal 43 11 25°6 19 3 15°8 62 22°
1947 9 2 222 6 ° ° 15 13°7
1940-47 1,034 s7 EM) 134 34 25°4 1,168 13°3
Males aged 35-54
1940 65 ° ° ° ° ° 65 ° °
1941 ° ° 1 ° ° 9° ° °
1942 1 ° ° 5 2 40°0 129 2 16
1943 1 2 ar 6 28-6 107 7 os
1944 126 2 16 19 7 36°8 145 9 6-2
194: 116 16 13°8 24 I 42 140 17 12)
1948 14 3 21-4 13 1 V7 27 4 14°8
1947 1 ° ° 2 ° ° 3 ° °
1940-47 621 22 3°5 85 7 20°0 706 390 s°s

The order in which the diagnoses were recorded on the card depended
on whether the coder considered, from the case history, that the patient
was admitted on account of a prolapsed disc or because he had an attack
of sciatica. The last column of Table 28 shows that the number of cases
in which the two conditions were associated increased year by year
until 1946. Taken over the eight years 1940-47, the difference between

674 CASUALTIES AND MEDICAL STATISTICS

the percentages in the two age groups is significant. (Difference
7°8.2S.E. = 2:6).

Sciatica did not show any variation in seasonal incidence beyond a
general tendency to be higher in the winter months. The numbers of
men admitted during the four 13-week periods of each year from 1940-
45 were as follows:

1940 1941 1942 1943 1944 1945
1st Quarter 30 86 89 60 74 93
2nd Quarter 43 67 75 57 7° 81
3rd Quarter 47 53 75 73 67 54
4th Quarter 65 58 74 66 92 45

Table 29 shows the distribution of days of in-patient treatment and
the median number of days’ stay for sciatica, the more frequently
occurring types of neurosis and functional dyspepsia. For sciatica, the
median was 53 days for men aged 15-34, compared with 50 days for
those aged 35-54 and 32 days for women at ages 15-34. The younger
men had median periods of treatment in excess of those of the older
age group for psychophathic personality, anxiety and obsessional states
and reactive depression, while for hysteria the medians were the same.
In all cases the median was about six or seven weeks. Median periods
for women patients were less than those for men except for reactive
depression. The median for functional dyspepsia was about three weeks
for men and a fortnight for women.

DISEASES OF EYES AND EARS (Short List Numbers 14 and 15)

These two groups of diseases made a comparatively small contribu-
tion to the basic total of admissions, the ratios for males of all ages
varying, for eye diseases, between 11 and 15 per 1,000 and for ear
conditions between 20 and 36, the corresponding figures for females
being 7 to 9 and 16 to 28. The rates did not vary greatly from year to
year nor as between age groups.

Diseases of the conjunctiva formed 32-4 per cent. of all eye conditions
for men and 33-1 per cent. for women, corresponding figures for
diseases of the cornea being 27-3 per cent. and 15-8 per cent. and for
affections of the lids and lachrymal apparatus 15-6 per cent. and 19:0
per cent. Among women strabismus formed 13-6 per cent. of eye
conditions, compared with 3-9 per cent. among men, but possibly
women are the more likely to seek treatment for this complaint.

Rather more than three-quarters of all ear diseases, both for men
and women, consisted of otitis media with or without mastoiditis. An

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676 CASUALTIES AND MEDICAL STATISTICS

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THE EMERGENCY MEDICAL SERVICES 677

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678 CASUALTIES AND MEDICAL STATISTICS

estimated total of about 17,500 males and 1,650 females were admitted
for this primary cause.

DISEASES OF HEART AND ARTERIES

Service men and women would constitute a highly selected population
in respect of heart disease, but for both sexes at all ages about 1 per cent.
of the basic total of admissions was due to a condition in M.R.C. code
numbers 38-42. The rates rose sharply with age, and for men in the
age group 45-54 the ratio varied between 4-3 per cent. and 9-2 per
cent. (Table 30).

TABLE 30

Diseases of Heart and Arteries (M.R.C. Codes 38-42)
Proportion per 1,000 Admissions for Non-infective and Non-respiratory
Illnesses, 1940-47

Males

Year Age Groups

15] 25—| 35-| 45-| 55

6) 7] 17 | 44 | 107
6 5 8 | 61 | 128
7| 7] 10] 45 | 146
6] 6] 10] 59] 97
4 6 | 13 | 50 | 108
6] 8/415) 43] 97
8 | 10 | 20 | 69 | 251
5 | 12] 31 | 92 | 167

Among men the proportion of cases of heart disease believed to be
of rheumatic origin, to all cases of heart disease, varied from year to year
as follows:

1940 1941 1942 1943 1944 1945 1946-47 1940-47
per cent. per cent. percent. percent. percent. percent. percent. per cent.
36 39 48 45 47 59 44 45

The corresponding proportion for women taken over the whole eight
years was 43 per cent. High blood pressure accounted for 23 per cent.
of all admissions of men for diseases of the heart and arteries, and
9 per cent. of those of women. Taken over the whole period the number
of men admitted in each age group per 10,000 total admissions in that
group was as follows:

Age 15s- 25- 35- 45- ssup All
3 7 27 122 231 12

THE EMERGENCY MEDICAL SERVICES 679

In the sample 119 men were admitted during the eight years with
diseases of the coronary arteries. Their proportionate age distribution
compared with that for all heart disease was:

Ages 1s | 25 3s- | 45- | ssup | All
Coronary Disease. 4 8 210 378 303, 101 1,000
All Heart Disease. ys 222 306 276 159 37 1,000

DISEASES OF THE VEINS (Short List Number 18)

Admissions for treatment of diseases of the veins, of which the three
of most frequent occurrence were varicose veins of the legs, haemor-
rhoids and varicocele, accounted for a proportion of the basic total
varying between 44 and 89 per 1,000 admissions for men and 19 and
41 for women. Table 31 shows that for men the rates were much higher

TABLE 31

Diseases of the Veins
Proportion per 1,000 Admissions for Non-infective and Non-respiratory Illnesses, 1940-47

Males Females

Year Age Groups

15-| 25- | 35~ | 45- |55 up| All

1940. : -145]| 97] 80] 98] 94] 71
1941. . - | 58 | 102 | 123 | 108 73 | 89
1942. ‘ . | 56 98 | 105 | 104 73 | 85
1943 - hs 145 92 | 106 | 81 | 113 | 78
1944. : - 147 | 86] 100} 73] 27] 75
1945 - : +145) 79] 75] 71 | 32 | 66
1946. : +145 | 77] 63] 42] 167 | 590
1947. : -| 38] 61] 93] 45 | —]| 44

at ages 25 and over than at ages 15-24; from 1941 to 1944 admissions
for these diseases accounted for at least 10 per cent. of the basic total
of admissions of men aged 35 to 44. Among women, the rates also
showed a tendency to increase with age.

Table 32 shows that about 34,000 men are estimated to have been
admitted for varicose veins of the legs during the eight years under
review, and 25,000 for haemorrhoids. The corresponding figures for
women are 2,300 for varicose veins and goo for haemorrhoids.

RESPIRATORY DISEASES (Short List Numbers 19-21)

Diseases of the respiratory system comprise the diagnostic terms
included in the Short List Numbers 19, acute primary pneumonia, 20,

680 CASUALTIES AND MEDICAL STATISTICS

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THE EMERGENCY MEDICAL SERVICES 681

bronchitis and tracheitis and 21, other respiratory diseases. As these
diseases have a marked annual variation and their incidence is affected
by such external causes as adverse climatic conditions they have been
excluded from the basic total of admissions.

TABLE 33
Respiratory Diseases
Proportion per 1,000 Admissions for Non-infective and Non-respiratory Illnesses, 1940-47
Males Females
Year Age Groups Age Groups

15- | 25- | 35- | 45- | ssup| All | rs- | 25- |35-44| All
Acute Primary Pneumonia (Short List. No. 19)
1940 33 24 18 32 23 28 16 17 20 17
1941. 37 28 22 14 18 30 19 29 12 20
1942. 42 29 31 44 102 35 21 gr 24 23
1943. . | 46 32 38 49 32 38 17 14 37 17
1944 . | 43 32 33 50 68 37 14 26 17 16
1945 . | 63 35 43 46 | 129 46 27 18 16 24
1946 . | 65 39 37 42 83 52 19 6 38 17
1947. | 72 49 72 45 | 167 68 19 = _ 16
Bronchitis and Tracheitis (Short List No. 20)
1940. | 47 53 | 124 | 197 | 436 66 52 | 100 | 137 75
194r . | 42 50 85 | 156 | 363 55 54 97 99 66
1942. | 45 56 84 97 87 58 34 52 73 39
1943. | 40 | 43 or | rsx | 324 5 32 42 74 36
1944 . go 34 50 118 68 3 22 36 61 28
1945 . | 33 26 45 7. | 225 33 24 26 32 26
1946 . 25 18 37 28 83 24 27 25 _ 27
1947. 25 12 41 137 _ 25 24 go _ 24
Other Respwratory, Dene (Short List No. 21)
1940 2: 34 25 8 20 20
1941 1 37 27 49 63 34
1942 43 39 33 34 6 33
1943 48 41 29 27 5 29
1944. 41 39 27 34 22 29
1945 - 97 | 41 20 15 39 19
1946. 83 46 42 | 45 — | 41
1947 66

Admissions for acute primary pneumonia among men at all ages bore
a ratio to the basic total of admissions which increased from 28 per
1,000 in 1940 to 68 per 1,000 in 1947, while for bronchitis and trach-
eitis the ratio declined from 66 per 1,000 in 1940 to 24 per 1,000 in
1946. For women at all ages the ratios for acute primary pneumonia var-
ied between 16 and 24 per 1,000, without showing a definite trend over
the eight years, but for bronchitis and tracheitis they showed a decline
from 75 per 1,000 in 1940 to 24 per 1,000 in 1947. The ratios for other
respiratory diseases, of which chronic bronchitis showed the highest in-
cidence, increased steadily over the eight years from 34 to 66 per 1,000

682 CASUALTIES AND MEDICAL STATISTICS

for men, while those for women varied between 19 and 41 per 1,000.
For males the ratios for acute pneumonia and for the group ‘other
respiratory diseases’ were higher at ages 15-24 than at 25-34, while for
bronchitis and tracheitis they were higher at ages 25-34 from 1940 to
1944 but lower than at ages 15-24 from 1945 to 1947. The decline with
age in the ratios for ‘other respiratory diseases’ continued at 35-44,
while those for acute pneumonia showed on the whole an increase in this
age group over the preceding decennial group. Women’s ratios for
bronchitis and tracheitis showed a definite upward trend over the
three age groups, but for acute penumonia and ‘other respiratory dis-
eases’ there was considerable variation between age groups and from
year to year.

TABLE 34

Pneumonia. Proportionate Constitution of Admissions classed to Short List
Group 19. Males, 1940-47

_Year of Admission
M.R.C. Diagnoses —
Code 1940] 1941 aoaa 1343 | 1944 | 1945 |1946-|1940-
47
450 eebar pretmonia’ ei pneumonia # ira 45 50
451 Broncho-pneumonia . 21 21 2
452. | Pneumonia | Pneumonia unspecified | | 3 | 26| 34 29

Pneumonia all Pneumonia all forms. 100

Table 34 shows the proportions in which lobar, broncho- and un-
specified forms of pneumonia were represented in the diagnoses classed
to Short List Number 19. Roughly, out of every 10 such admissions, 5
were attributed to lobar, 2 to broncho-pneumonia and 3 to pneumonia
not otherwise specified. It is estimated that between 30,670 and 31,460
men and from 1,930 to 2,130 women were admitted to hospital for
pneumonia in one or other of its forms during the eight years under
review.

Apart from the pneumonias the numbers of admissions were highest
for those respiratory diseases shown in Table 35. The total number of
men estimated to have been admitted for chronic bronchitis without
mention of emphysema was between 28,860 and 30,540 and is therefore
slightly less than that for all forms of pneumonia. Acute bronchitis
represented two-ninths of all cases coded to bronchitis. The sex-ratio of
numbers of admissions of males to females for acute bronchitis was 9:1,
for chronic bronchitis 11-4 and for bronchitis with emphysema 100-4.
The sex-ratio for pleurisy with effusion was 7-6 whereas for other forms
of pleurisy it was 11°5.

683

THE EMERGENCY MEDICAL SERVICES

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684 CASUALTIES AND MEDICAL STATISTICS

TABLE 36

Quarterly Admissions detesione for Acute Bronchitis, Lobar Pneumonia and
Unspecified. Persons, 1940-45

M.R.C.
Code Diseases Season 1943 1944 1945
446 Acute Bronchitis . Ist 125 123 205 169 96 92
and Sure 35 52 9° 92 4r 43
3rd Quarter 31 45 4! 40 ar
4th Quarter 187 B 37

1st Quarter

Lobar Pneumonia .

Table 36 shows the number of admissions for acute bronchitis, loba,
and unspecified pneumonia in periods of thirteen weeks. The seasona
fluctuations in these three conditions show in the main similar patterns
with highest incidence in the first quarter and lowest in the third. The
variation in the number of cases assigned to unspecified forms of
pneumonia was not as wide as in the other two diseases. During the
winter of 1943-44, the peak number of cases of both acute bronchitis and
pneumonia unspecified occurred in the last quarter of 1943, thus
resembling the occurrence of the peak of the influenza epidemic of that
period. On several occasions the peak number of admissions for two or
more of these diseases occurred simultaneously, as may be seen from
the following:

Week of occurrence of highest number of weekly admissions

Acute Lobar Pneumonia
Influenza Bronchitis Pneumonia N.O.S.
1940 Weekending 27th Jan. 27th Jan. 2nd Mar. 2oth Jan.
1941 Weekending 8th Feb. 8th Feb. 25th Jan. 8th Feb.
1942 Weekending 28th Feb. 7th Mar. 7th Mar. 28th Feb.
1943 Weekending 16th Jan. 23rd Jan. 23rd Jan. 3rd Apr.
1943-44 Week ending 27th Nov. 27th Nov. 25th Mar. 4th Dec.

From Table 37 it would be seen that the median period of in-patient
treatment for uncomplicated cases of acute bronchitis varied for men
aged 15-34 between 15 and 19 days. If the figures for the seven years
1940-46 be combined, the median period for men aged 15-34 and those
aged 35-54 was 17 days, while for women aged 15-34 it was 14 days.
It is probable that the large number of men who were in hospital for
70 days of more were suffering from an acute exacerbation of a chronic
bronchitis, rather than an attack of acute bronchitis.

THE EMERGENCY MEDICAL SERVICES 685

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686 CASUALTIES AND MEDICAL STATISTICS

During the war years an increasing interest was taken in primary
atypical pneumonia. This condition, which was classed to 4514 in the
M.R.C. Classification, covers the following diagnostic terms shown in
No. 492 in the International Statistical Classification of Diseases,
Injuries and Causes of Death, 1948.

Pneumonia, ages 4 weeks and over Pulmonitis (acute), ages
specified as: 4 weeks and over
acute interstitial Pulmonitis (unknown
atypical (primary) aetiology), ages 4 weeks
unknown aetiology and over
virus

In the one-in-five sample there were 360 men and 44 women ad-
mitted with one of these diagnoses, corresponding to a total of about
2,000 admissions during the eight years 1940-47. The distribution of the
cases by age and sex is shown below.

TABLE 38

Atypical Pneumonia (M.R.C. Code 4514). Distribution of Admissions
by Sex and Age, 1940-47

| w 3d cow cow

Totals

r)

w

In this series two deaths were recorded, one from virus pneumonia.
The second case was of a patient who was also stated to have had tuber-
culous meningitis. In fourteen cases, or 3-5 per cent., there was mention
of pleurisy.

Over the period 1940-46 the term pneumonitis has tended to be re-
placed by the use of primary atypical or virus pneumonia.

It is difficult to tell from such a small number of cases whether or
not there is a seasonal trend in the incidence of this condition; all that
can be said from examining the numbers of admissions in periods of

THE EMERGENCY MEDICAL SERVICES _ 687

TABLE 39
Atypical Pneumonia. Proportionate Composition of Admissions for M.R.C. Code 4514

Diagnoses 1940 | 1941 | 1942] 1943 | 1944] 1945 | 1946 | 1947 |1940—

47
Pneumonitis . + | 100] 95 47
Pneumonia, primary,
atypical. ‘ . _ 5 49
Pneumonia, virus,

atypical

thirteen weeks is that admissions were lowest in the third quarter,
except in 1945.

Admissions in Periods of Thirteen Weeks

1940 1941 1942 1943 1944 1945 1946 1947
1st Quarter . I II 3 9 28 34 21 10
2nd Quarter . ° 16 4 13. 49 37 2 4
3rd Quarter . 3 11 I 10 46290—COd17 3 I
4th Quarter . 5 17 2 13 40 12 4 1

The median period of in-patient treatment was 38 days for men aged
15-34 and 33 days for those aged 35-54. If the mean were taken instead
of the median it would give 49 days for the younger and 41 for the older
men.

ACUTE HEPATITIS AND JAUNDICE (Short List Number 24)

During the war there was an increased incidence of JAUNDICE, which
affected our troops both in this country and overseas. Witts (1944)
stated that infective hepatitis was one of the three most important dis-
eases in the Mediterranean theatre, the others being malaria and venereal
disease. At home, the increasing prevalence of infective types of
jaundice caused the Minister of Health to issue, in 1943, the Jaundice
Regulations, by which the notification of catarrhal, toxic and infective
jaundice and of acute inflammation, necrosis or atrophy of the liver was
made compulsory in the Eastern Region. The Minister was influenced
in his choice of district by the existence of a research team working at
Cambridge in collaboration with the Medical Research Council.
Previous wars had brought epidemics of infective hepatitis in their train,
but in this one the use of blood products in the treatment of casualties
and the increase in parenteral therapy particularly with arsenical com-
pounds added the problem of jaundice caused by the transference of an

688 CASUALTIES AND MEDICAL STATISTICS

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689

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690 CASUALTIES AND MEDICAL STATISTICS

icterogenic agent in the blood from one person to another. The condition
known as HOMOLOGOUS SERUM JAUNDICE* had been previously recog-
nised among patients who had received vaccination against yellow fever,
the virus used for this purpose being suspended in human serum. Cases
had been reported from South America and the United States, as well
as in this country. Biological studies of the liver (Dible, McMichael
and Sherlock, 1943) showed that the same cytological changes occur in
all these instances, so pointing to a like aetiology, and suggesting that
these several causes produce a parenchymatous hepatitis.

Table 41 shows that in the sample 4,022 men and 250 women were
admitted to E.M.S. hospitals with hepatitis or jaundice during 1940-47,
corresponding to a total of about 21,000 cases. These figures do not
include cases of jaundice known to have followed blood transfusion,
which will be discussed later. Infective hepatitis (‘catarrhal jaundice’)
accounted for 862 out of every 1,000 cases and cases of symptomatic
jaundice in which no more definite diagnosis was made before discharge,
for another 66 per 1,000. Post-arsphenamine jaundice, toxic hepatosis,
cirrhosis of the liver and acute yellow atrophy contributed 41, 19, 7 and
5 per 1,000 respectively.

Among the 4,099 cases admitted other than for arsenical jaundice
during the eight years, there were 31 deaths, a case-fatality rate of 7-6
per 1,000. From infective hepatitis alone there were 9 deaths in 3,684
cases, or 2-4 per 1,000. This agrees well with Bradley’s surmise of 1
death in 500 cases with icterus (Bradley, 1944). Of 29 patients admitted
with cirrhosis, 11 died, a case-fatality rate of 38 per cent., the corres-
ponding rate for acute atrophy of the liver being 43 per cent.

‘TABLE 42

Acute Hepatitis and Jaundice. Proportion per 1,000 Admissions for
Non-infective and Non-respiratory Ilinesses, by Sex and Age, 1940-47
(Cases of Post-arsphenamine Jaundice are excluded)

Pltesritd

* See p. 787.

THE EMERGENCY MEDICAL SERVICES _ 691

From Table 42 it will be seen that the proportion of admissions for
acute hepatitis and jaundice (M.R.C. codes 540-543 and 7686) per
1,000 admissions for non-infective and non-respiratory illnesses in-
creased for both sexes from 1940-43, declined slightly in 1944 but rose
again in 1945, afterwards decreasing in 1946 and 1947. During the
latter half of 1943 and the beginning of 1944, the male Service popula-
tion in this country was increased by the return of a large number of
troops from the Mediterranean area. As jaundice had been very rife
among our Forces during the North African campaign, it is possible
that some of the cases admitted to hospital were already incubating the
disease before sailing for home, or were infected during the journey.
The increased rates for 1945 may be attributable to cases among the
influx of men returning from Sicily, Italy, the Far East and the prison
camps of Germany, in all of which there had been a heavy incidence of
jaundice. The proportionate rates for men were highest from 1940-44
in the age group 15-24, and these decreased with advancing age, while
from 1945 to 1947 they were highest at ages 25-34. Among women,
from 1942 to 1946, the rates were highest at ages 25-34. The propor-
tionate rate for males in 1945, the peak year, was five and a half times
that for 1940.

The distribution of cases of infective hepatitis by season and region is
shown in Table 43. The general trend is towards an autumn-winter
maximum and summer minimum, not only for the country as a whole
but in the three sub-divisions, Scotland, the six northern counties and
Cheshire, and the rest of England and Wales. Despite the fact that the
regional distribution of hospital cases is to some extent governed by the
number of beds available, it would nevertheless appear that there was
a high incidence in the South Eastern Region.

In the years preceding the war, evidence that hepatitis was due to a
virus had been accumulating, and in the Sixth Revision of the Inter-
national Classification of Diseases, Injuries and Causes of Death
(1948), infective hepatitis is included in the group of diseases attribu-
table to viruses, instead of in the diseases of the liver. Greenwood (1944)
had noted in the case of influenza and encephalitis lethargica, that when
influenza increases, there appears to be some increase in encephalitis.
Assuming hepatitis to be due to a virus and spread by droplet infection,
it would be interesting from the epidemiological point of view, to see
whether or not it had any connexion with other respiratory diseases
caused by a virus. Table 44 shows the quarterly admissions to E.M.S.
hospitals for infective hepatitis and influenza and colds, and the quar-
terly notifications made to the Registrar General of acute poliomyelitis,
cerebro-spinal fever and acute encephalitis lethargica during 1941-46.
The highest incidence of influenza and colds occurred in the first
quarter of each year except in the winter of 1943-44, when the peak of

23CMS

692 CASUALTIES AND MEDICAL STATISTICS

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THE EMERGENCY MEDICAL SERVICES 693

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694 CASUALTIES AND MEDICAL STATISTICS

the epidemic was reached before Christmas. It is apparent from Table
44, that except for an unusually large number of cases in the third
quarter of 1945, acute encephalitis lethargica followed the same pattern
as influenza, the peak occurring before Christmas during 1943-44.
Allowing for the decrease in the number of cases of infective hepatitis in
1946 due to demobilisation, the trend of incidence is similar to that of
influenza. On examining the notifications of acute poliomyelitis and
acute polio-encephalitis, in which the virus attacks the central nervous
system, a maximum incidence in the September and December
quarters is observed, while in the case of cerebro-spinal fever, a non-
virus disease which affects the central nervous system, the peak inci-
dence occurs in the first quarter of each year. The trend of the winter
epidemic of hepatitis was similar to that of influenza during the periods
1941-42, 1942-43, and 1943-44, but during the winters of 1944-45
and 1945-46, jaundice admissions were highest in the fourth quarter
and influenza in the following first quarter. The apparent similarity
between the incidence curves of influenza and hepatitis may be entirely
accidental, the incidence of jaundice having been affected by the opening
of the North African and Sicilian campaigns in 1942 and 1943 and of
the Western Front in 1944.

Table 45 shows the duration of stay in hospital and the median num-
ber of days of treatment. For men aged 15-34 admitted for infective
hepatitis, the median period of incapacity varied from year to year
between 25 and 36 days, the average over the seven years 1940-46 being
31 days. For men aged 35-54 the median period was 43, while for women
in the younger age group it was 20 days. This may be compared with
the statement of Witts (1944) that in the Mediterranean theatre the
average stay in hospital was about 15 days, with a further month at a
convalescent home. Of the younger men, 36 per cent. were in hospital
for less than 3 weeks, 55 per cent. for less than 5 weeks, and about 20
per cent. were incapacitated for upwards of 10 weeks. The short
duration in hospital in some cases is accounted for by the fact that they
were men who had developed jaundice on board ship and were admitted
to E.MLS. hospitals on disembarkation. For symptomatic jaundice, the
median period was about 4 weeks for men and 3 weeks for women,
while for men with arsenical jaundice it was about 6 weeks.

The case histories of 167 patients with infective hepatitis recorded a
previous attack of the disease, a re-infection rate of 4-5 per cent. With-
out a control series it is impossible to conclude whether an attack of
infective hepatitis confers any immunity or whether on the contrary it
renders the subject more liable to a subsequent attack. The age distri-
bution of patients stated to have had a previous attack of jaundice,
with the mean age at attack and the mean interval between the present
attack and the preceding one, is shown in Table 46.

THE EMERGENCY MEDICAL SERVICES 695

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696 CASUALTIES AND MEDICAL STATISTICS

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THE EMERGENCY MEDICAL SERVICES 697

TABLE 46

Age Distribution of patients with a previous attack of jaundice, mean age
at previous attack and mean interval between attacks

Mean age at previous attack, Mean age at previous attack,
Age at using whole range excluding those with over
present 20 years before the second
attack
Number | Mean age
Under 20 9 15

22: 57 18-5

27% 52 21-8

32¢ 26 23°7

37¢ 20 31°6

424 3 41-0

The curve of age at previous attack appears to be bimodal, with maxima
in the age groups 10-14 and 20-24. During 1948 there were 928
Notifications of ‘jaundice’ in the Eastern Region (Report of the Chief
Medical Officer on the State of the Public Health for 1948), with a
bimodal age distribution of cases, having maxima at ages 5-9 and 20-24.
In the course of an investigation into reasons for absence from school
conducted by the Ministries of Health and Education it was found that
of 117 children who remembered an attack of jaundice, apart from that
of the newborn, 16 were under 5, 71 from 5 to g and 30 from 10-14
at the time of the attack.

Ten men who had been treated for venereal disease had had previous
attacks of jaundice, but in only one case was the attack dissociated from
N.A.B. injections. One patient reported seven attacks between April
1944 and December 1945.

The first symptoms mentioned in 3,615 cases of infective hepatitis
occurred in the following order of frequency:

Nausea . . 644 Bile-stained urine 200
Anorexia - 635 Chill, rigor . - 137
Abdominal pain 577 Pyrexia + 135
Vomiting - 399 Diarrhoea . . 86
Jaundice . 260 Backache . . 77
Headache . 244 Paininlimbs . 58

Influenza . . 58

Constipation . 47

Pale stools. - 34

Sore throat » 19

Coma : ‘ 4

698 CASUALTIES AND MEDICAL STATISTICS

Of the types mentioned by Bradley (1944) there were 31 cases either
following or associated with tonsillitis and two with enteritis, while
two cases had been preceded at intervals of one week and 10 weeks
respectively by an attack of food poisoning. Eleven cases were associated
with glandular fever, while in several cases it was noted that there were
painful and enlarged glands, although no more definite diagnosis was
made.

Certain other symptoms may arise in the course of the illness, and of
these the one most frequently observed was pruritus which was stated to
be present in 299 cases and absent in 294. It generally increased in
intensity at night and was often confined to the lower limbs. Other
symptoms were stated to be present (or absent) in the following des-
cending order of frequency; vertigo 100 (11); rash 73 (32); dyspnoea 52
(51); tachycardia 22 (24). Conjunctivitis or other inflammatory con-
ditions of the eyes were recorded in 11 cases, and herpes in 20 cases of
which 10 were diagnosed as herpes labialis.

Linsey (1943) has stated that complications of infective hepatitis are
supposed to be very rare. Cullinan (1939) refers to a case of parotitis and
Maitland and Winner (1939) to one of odphoritis. In this series there
were two patients admitted with a primary diagnosis of mumps with
subsequent jaundice and two admitted primarily for jaundice who
developed mumps. One man developed orchitis and epididymitis. It is
possible that in some cases there may have been an involvement of the
pancreas; one case was recorded in this series of chronic hepatitis and
chronic pancreatitis, and a second in which the primary cause of
admission was pancreatitis, jaundice subsequently developing in
hospital. In two cases glycosuria was mentioned, but no record was
found of diabetes.

Some virus diseases such as mumps and measles may under certain
circumstances attack the nervous system, and it is not surprising to
find nervous complications following infective hepatitis. Lescher (1944)
has mentioned meningitis, paralysis of the limbs and polyneuritis.
While no cases of meningitis were found in this series, there was one
case in which facial paralysis occurred and others showing symptoms
of involvement of the nervous system, such as weakness in the legs and
feet and neck-rigidity.

In all the cases of association of other diseases with infective hepatitis
mentioned above, the case histories were examined to see whether
there had been a previous attack of jaundice. The only such record
was of a case of glandular fever and hepatitis in which an attack of
jaundice had occurred ten years previously.

It would be impossible in this survey to attempt to trace a connexion
between cases of jaundice. In 279 cases there was no known contact
with jaundice and no other cases in the unit, while in 190 cases direct

THE EMERGENCY MEDICAL SERVICES 699

contact or the occurrence of other cases in the same billet, unit or ship
was admitted. The periods of time stated to have elapsed between the
possibility of contact and the present illness were distributed as follows:
Under 2 weeks 2 wks. 3 wks. 4 wks. 5 wks. 6 wks. 7 wks. 8 wks. 12 wks.
7 II Io 25 7 I 1 I 3

Suggestions have been made that the incidence of hepatitis is greater
among commissioned, than among other ranks. Cold has been suggested
as one of the predisposing factors to an attack of jaundice, and the
high incidence among British air crews, who may be exposed to cold
at high altitudes, and among British officers, who undress at night, has
been cited. But as Witts (1944) points out, neither American officers
nor American flying personnel show an incidence above the normal,
and in the R.A.F. steps were taken to prevent chilling at unaccustomed
heights. The distribution of infective hepatitis among male com-
missioned, non-commissioned and other ranks for the three Services
combined is shown in Table 47, but it has not been possible to get
comparable figures for the population at risk.

TABLE 47
Distribution of Infective Hepatitis by Rank. Males, 1943-45

1943 1944 1945 1943-45
Rank
Per Per Per Per
Number] cent. | Number] cent. | Number] cent. | Number | cent.
Commissioned 82 11 40 6 16 2 138 6
Non-
commissioned 233 31 217 jo 263 32 713 31
Other ranks 427 58 459 64 534 66 1,420 63
Totals 742 100 716 100 813 100 2,271 100

The possibility of the disease being acquired through association with
rats, as in the case of Weil’s disease, has been considered. In this
series nineteen men were known to have come into contact with rats
or rat-infested premises, while twenty-six stated that there had been
no likelihood of such contact.

The distribution by age, civil state and branch of Service of 173 men
who developed jaundice following arsenical therapy was as follows:

Age Civil State Branch of Service
No. Percentage No. Percentage No. Percentage

15-24 59 34 Single 31 18 Army 126 73
25-34 «79 46 Married 80 46 Navy 26 15
35-44 31 18 Widowed or Air Force 21 12
45 up 4 2 Divorced I 1

Not stated 61 35
Totals 173 100 173 100 173 100

23*CMS

joo CASUALTIES AND MEDICAL STATISTICS

The median period of treatment in hospital was 44 days. Thirty-four per
cent. were in hospital for less than 4 weeks, 28 per cent. from 4 to 8
weeks, 29 per cent. from 8 weeks to 3 months and ro per cent. for
3 months and over.

The first mentioned symptoms in this series of cases were, in descend-
ing order of frequency, nausea and bile-stained urine, 18; anorexia,
16; abdominal pain, 14; vomiting, 13; jaundice, 9; others, 14.

The onset of jaundice occurred at varying times during treatment.
In 73 cases jaundice appeared as follows:

During the first course 3 After the first course 28
: » second ,, 19 » » second ,, 9

» third ,, 2 » 9, third » 8

» » fourth ,, 3

» » eighth , I

In a further 12 cases in which courses were not distinguished, the
number of injections given before jaundice appeared was 1, 2, 3, 5, 6,
8(2), 10, 13, 16, 20, and weekly for two years. The number of cases
reported here is too small for any definite conclusion to be drawn.
Nevertheless, the appearance of jaundice in a comparatively large
number in the earlier stages of treatment would appear to support the
view that the disease is due to the introduction into the blood of an
infective agent, rather than the toxicity of arsenicals to the liver.

Two patients admitted with a diagnosis of acute atrophy of the liver,
one of whom died, had previously had attacks of jaundice following
treatment for syphilis, and a third who had previously had arsenical
therapy died of portal cirrhosis of the liver.

HERNIA (Short List Number 25)

During the eight years 1940-47, 12,263 males and 98 females in the
sample were admitted for hernia. Of these 11,324 men had inguinal
hernia without obstruction or strangulation as the primary diagnosis,
the corresponding total number of admissions for this cause being
from 56 to 57 thousand.

Table 48 shows that as a principal cause of men’s admissions to
hospital hernia and intestinal obstruction varied between one-tenth of
the basic total of admissions in 1940 and one-twentieth in 1947. Between
1941 and 1947 the proportion was highest in the age-group 35-44,
while at ages 15-24 it declined steadily from 94 in 1940 to 48 in 1947.
Hernia made an insignificant contribution to causes of admission of
women.

THE EMERGENCY MEDICAL SERVICES 701
TABLE 48
Hernia. Proportion per 1,000 Admissions for Non-infective and
Non-respiratory Illnesses, by Sex and Age, 1940-47
Males Females

Year Age Groups Age Groups

15- | 25- | 35- | 45- |ss5up|{ All | rs- | 25- |35 up| All
1940 94 121 81 84 59 101 5 7 — 7
1941 70 89 100 70 oI 83 6 24 _ 8
1942 66 64 80 62 14 68 3 3 6 3
1943 59 58 75 64 32 62 3 Te Neto 4
1944 62 55 69 24 13 60 6 6 17 6
1945 59 58 95 7 32 66 4 I 16 3
1946 52 82 117 mr _ 71 3 13 — 4
1947 48 55 82 50 SS

The total numbers of admissions for hernia, with or without obstruc-
tion, and the percentages of cases of inguinal, femoral and umbilical
hernia described as gangrenous, incarcerated or irreducible or with
obstruction or strangulation are shown in Tables 49 and 50.

‘TABLE 49
Number of Admissions for Hernia, by Sex and Age, 1940-47

Males Females
M.R.C.
ede DIAGNOSES Age Groups Age Groupe
lo.
1s- | 25- | 35- | 45- |ssup| All 15-|25-|35 up| All
$200 Inguinal, without
obstruction 3,956 | 4,864 | 2,268 | 221 15 11,324 | st | 17 s | 73
5201 Inguinal, with
obstruction ros} 138] 47] 3 | — 383) tr} —-| — | *
5210 Femoral, without
obstruction 42 81 5S7 7 - 187 2 12
Sarr Femoral, with
obstruction 1 6 10 1 - 18 1 2 ied 2
$220 Umbilical, without
obstruction < 17 22 4 4 _ 5S7 rl|— _ 1
5221 Umbilical, with
obstruction 1 2 r 1 = s{—|-| -—|]-—
523 Incisional 30 35 ar 3 - 89] 3] 2 1 6
524 Diaphragmatic 3 1 2]—-]—- 6;—|—| —|[-
525 Other or
Ill-defined 59 76 49 10 _ 194 2 t Sood 3
TABLE 50
Percentage of Cases of Inguinal, Femoral and Umbilical Hernia with obstruction,
Males, 1940-47
Males
M.R.C.
Code Diagnoses Age Groups
Number
15 25- 35 45- | ssup | All
520 Inguinal 4°7 2°8 2'0 1°3 — 3°3
521 Femoral 23 6-9 14°9 12°5 _— 8-8
522 Umbilical 5°6 8-3 6-7 20°0 _- 8-1

7oz2 CASUALTIES AND MEDICAL STATISTICS

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THE EMERGENCY MEDICAL SERVICES 703

Men aged 15-24 accounted for 35 per cent. of the total admissions for
inguinal hernia, and 21 and 29 per cent. of those for the femoral and
umbilical forms respectively.

The percentage of men with inguinal hernias with obstruction was
greatest at ages 15-24 and decreased with age, while femoral and
umbilical hernias showed generally the reverse trend. The difference
between the proportion with obstructed inguinal hernia at ages 15-24
and those in the next two decennial age groups is greater than would
be due to the chances arising in random sampling, (Difference + 2 S.E.
1-9 + 16; 2-7 + -9; 3:4 + 1-6) but there was no significant difference
between the other age groups. Similarly for femoral hernia, the propor-
tion with obstruction was significantly higher at ages 25-34 than
at 15-24, while for umbilical hernia there was no significant variation
between the age groups. If the proportions of obstructed inguinal and
femoral hernias in corresponding age groups be compared, the differ-
ence is significant only at ages 35-44 (12°9 + 8-7).

Table 51 shows that the median period of in-patient treatment among
men aged 15-34 increased from 27 days in 1940 to 69 days during
1944 to 1946, the median over the seven years being 47 days. For mates
aged 35-54 the median duration increased from 28 days in 1940 to
63 days in 1944, and then decreased to 58 days in the last two years.
The median period for women was about a fortnight less than for men.
Eighteen per cent. of those in the younger age group and 20 per cent.
in the older were in hospital for three months or more.

GASTRIC AND DUODENAL ULCERS (Short List Number 26)

The four types of ulcer included in this title are gastric (491),
duodenal (492), peptic (493) and gastro-jejunal (494), the term ‘peptic’
being employable only when it is not specified whether the ulcer was
gastric or duodenal. The proportions of the basic total of admissions
attributed to ulcers are shown in Table 52.

Among men the highest proportionate admissions for ulcers are found
in the age groups 35-44 and 45-54. In 1940 ulcers formed between
g per cent. and 11 per cent. of the basic total of admissions at ages
35 and over. These high rates, which occurred in the year of the French
collapse, declined at all ages during 1941-43, but there was an increase
in 1944 and 1945, synchronous with the establishment of a Western
Front. There was also an increase in the proportionate rates for women
in 1945, especially at ages 25-44. The average number of men admitted
during the five quarters January 1943 to March 1944 with a primary
diagnosis of gastric, duodenal or peptic ulcer was 225. In the period
from April 1944 to September 1945, quarterly admissions exceeded
this average by percentages of 47, 13, 31, 75, 69 and 20 for the six
quarters respectively. If persons with a certain type of psychological

7o4 CASUALTIES AND MEDICAL STATISTICS

TABLE 52

Gastric and Duodenal Ulcer: Proportion Bet 4.000 Adresses for
Non-infective and ‘Non: tespiratory (If by Sex and Age, 1940-47

Males

Age Groups

| 35- | 45- [ss up| All

luv ewnan

constitution are more prone to develop ulcers than their fellows, then
it may be that the increase in women’s rates was connected with an
increase of anxiety about the welfare of their men-folk, while men were
mainly affected by the stress of battle.

In the one-fifth sample of admissions there were during 1940-47
1,395 men admitted with gastric, 5,199 with duodenal and 387 with
peptic ulcers, corresponding to total admissions of 7,000 for gastric,
26,000 for duodenal and 1,900 for peptic. The ratio of duodenal to
gastric ulcers was therefore 3-7, though if individual years be considered
it was as high as 4-7 in 1942. While death statistics and hospital studies
such as that of the New York hospitals, 1933, have shown a pre-
ponderance of gastric over duodenal ulcers, common opinion has been
that the proportion of duodenal to gastric ulcers among the general
population was five to one or possibly higher. It has been shown that
the figures from E.M.S. hospitals and from the Survey of Sickness

TABLE 53

Percentage of gastric and duodenal ulcers with perforation and haemorrhage.
Males, 1940-47

Diagnoses

Gastric ulcer
4910 with perforation
4911 with 01
Duodenal ulcer
4920 with perforation

with haemorrhage

THE EMERGENCY MEDICAL SERVICES — 705

conducted by the Central Office of Information for the General Register
Office tend to support this view. (Brooke 1950).

Table 53 shows the percentages of gastric and duodenal ulcers with
perforation or haemorrhage in the various age groups. In both cases
the proportion of ulcers with perforation is highest at ages 15-24 and
decreases with age. This may indicate, not so much that a larger pro-
portion of ulcers perforate among young than among older men, but
rather that younger men are less likely to seek hospital treatment for
ulcers which are accompanied by neither perforation nor haemorrhage.
The differences between the percentages of gastric and duodenal
ulcers with perforation or haemorrhage in corresponding age groups
are:

With perforation With haemorrhage

Difference 2X Standard Error Difference 2 Standard Error
Age 15-24 22°8 7°62 2°79 2°90
25-34 16°8 3°84 3°2 1°96
35-44 10"4 3°80 mt 0°96
45-54 75 9°84 3°5 5°16

Hence the proportion of gastric ulcers with perforation is significantly
greater than that of duodenal in the three age-groups between 15 and
44, while the difference between those with haemorrhage is significant
at ages 25-34 and 35-44.

The case-fatality rates per 1,000 among males with gastric ulcers
with perforation, haemorrhage, or unqualified were 61, 31 and 2
respectively, the corresponding rates for duodenal ulcers being 47,
35 and 2. These rates are substantially lower than those for the New
York Hospitals, 1933, where the overall case-fatality rate for gastric
ulcers was 13 per cent. and for duodenal ulcers 7-6 per cent. The
difference is partly due to the necessity for sending to hospital men from
the Services who under civilian conditions would have been treated at
home, and partly to the difference in age structure of the populations
at risk.

GASTRO-ENTERITIS, APPENDICITIS AND OTHER DIGESTIVE
DISEASES (Short List Numbers 27-29)

The proportion of admissions attributed to gastro-enteritis was
fortunately not high, when war-time conditions among Service per-
sonnel are considered (see Table 54). The rates for males at all ages
varied between 11 and 20 per 1,000 basic admissions and for females
between 8 and 26.

706 CASUALTIES AND MEDICAL STATISTICS

TABLE 54

Gastro-enteritis. Proportion per 1,000 Admissions for Non-infective and
Non-respiratory Illnesses, 1940-47

Females

1940
1941
1942
1943
1944
1945
1946
1947

Appendicitis accounted for roughly one in twenty of men’s basic
admissions and from 12 to 24 per cent. of those of women. Table 55 shows
that the proportionate rates are highest for both men and women aged
15-24 and lower in the older age groups where many would have already
had an appendicectomy.

TABLE 55

Appendicitis. Proportion per 1,000 Admissions for Non-infective and
Non-respiratory Illnesses, 1940-47

The M.R.C. classification distinguishes cases of appendicitis com-
plicated by abscess, gangrene or perforation from those which were
unqualified or sub-acute. The proportion of such complications occur-
ring in each age group is shown in Table 56 below. From this it appears
that a higher proportion of cases were accompanied by gangrene than
by perforation or abscess. The proportion of uncomplicated cases was
highest in the lower age groups and decreased with age. At ages 15-34,

THE EMERGENCY MEDICAL SERVICES — 707

TABLE 56
Appendicitis. Proportionate Composition of Admissions
by Sex and Age, 1940-47

Appendicitis

5070 with abscess 49 By 26 96 22
5071 with Sangrene 100 2 28 19 26
5072 with perforation 37 10 9 = 10
5073 unqualified . 814 945 937 885 942

Totals

5°5 per cent. of men and 6-1 per cent. of women were in hospital for
less than 10 days, compared with 5-1 per cent. of men aged 35-54.
The case-fatality rate per 1,000 in each sex-age group was as follows:

Males Females
: ied 15-24 25-34 35-44 45 up All | 15-24 25-34 35 up All
With complications 11°30 1§'6 37°2 102°6 17°7| 1478 — — «9
Without complications}; 2-5 08 4°4 16°9 2:2] O°9 5°0 2r°7 1°8
All forms 4°90 3°4 II'5 51°O 5°0 1°60 4°7 19°2 2°4

Table 57 shows the distribution of days of in-patient treatment for
uncomplicated cases of appendicitis (M.R.C. code 5073). The median
period of treatment was about four weeks for men in both age groups
and three weeks for women. The proportions of men in hospital for less
than a fortnight were 13 per cent. and 12 per cent. in the two age groups,
compared with 20 per cent. of the women, but nearly a quarter of the
men were treated for eight weeks or more, compared with 4 per cent. of
the women.

Of the remaining diseases of the digestive system (Short List Number
29, see page 648) those occurring with the greater frequency are shown
in Table 58. The most important cause of hospitalisation in this group
was gastritis, for which in all about 14,500 men and 800 women were
admitted to hospital. The sex-ratios of numbers of males to females
admitted during the eight years for certain diseases of the digestive
system were as follows:

Gastritis 18-4 Appendicitis 3:1 Gastric ulcer 69-8
Duodenitis 103-7 Gastro-enteritis 7-6 Pepticulcer 91-2

The return of Service men from the Far East brought a number of
cases of sprue to the E.M.S. hospitals. In the one-in-five sample
106 males (90 Army and 16 R.A.F.) and 1 female (A.T.S.) were
admitted, their diagnoses being sprue 89, tropical sprue 10, recurrent
sprue 2, clinical sprue 1, sprue syndrome 2, steatorrhoea 1, idiopathic

708 CASUALTIES AND MEDICAL STATISTICS

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THE EMERGENCY MEDICAL SERVICES

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710 CASUALTIES AND MEDICAL STATISTICS

steatorrhoea 2 (including the female). The men’s age distribution was
15-24, 31; 25-34, 59; 35 and over, 16. Most of the patients had already
received treatment abroad, nevertheless their median stay in hospital
in this country was 67 days. The median period of treatment from the
onset of diarrhoea to discharge from hospital was g months. There
were two deaths, of which one attributed to sprue occurred 8 months
after the initial diarrhoea. The second, in which sprue was complicated
by macrocytic anaemia with terminal haemorrhagic broncho-pneumonia,
took place 4 months after the onset of diarrhoea. Of the remainder,
38 were discharged from the army, of whom 11 were re-categorised,
returned to unit, 4 were sent to other hospitals, 19 were stated to have
been discharged from hospital without indication of their future and
for 4 there was no information. Anaemia was mentioned as a complica-
tion in 4 cases, while g cases were accompanied by malaria and 1 by
amoebic dysentery.

DISEASES OF THE FEMALE GENITAL ORGANS (Short List Number 30)

AND NORMAL AND ABNORMAL CHILDBEARING (Short List Numbers
32, 33)

Table 59 shows that about one-tenth of the basic total of admissions
was attributable to diseases of the female genital organs. The propor-
tionate rates were higher on the whole at ages 25-34 than at 15-24.

TABLE 59
Diseases of the Female Genital Organs and Normal and Abnormal
Childbearing. Proportions per 1,000 Admissions for Non-infective and
Non-respiratory Illnesses, by Age, 1940-47

Diseases of Female Normal and Abnormal
Genital Organs Childbearing

For all ages together the rates increased up to 1945. Normal and abnor-
mal childbearing caused between 3 and 7 per cent. of the basic total.
The rates were highest in 1944 and 1945; in the general population the

THE EMERGENCY MEDICAL SERVICES 711

birth rate reached a maximum in 1944, declined in 1945 and increased
in 1946.

TABLE 60
Proportionate Distribution of Diseases of the Female Genital Organs, 1940-47

Total
M.R.C. Diagnoses Numbers | Proportions
Code No. (Sample)

600-603 Diseases of the breast . : A 3 136 59
605-606 Salpingitis and odphoritis i: 202 87
604; 607 Other diseases of ovaries and Fallopian

tubes , : fs 42 18
608 Diseases of the parametrium . 2 17 7
610 Cervicitis . . S : . 3 365 158
611 Genital prolapse . ‘ ‘i 20 9
612-613 Malposition of uterus; chronic

subinvolution . ‘ : 4 i 11 48
6140 Amenorrhoea xs ‘ ie 4 . 91 39
6141 Dysmenorrhoea_. ri a " es 504 218
6142-6144 | Menorrhagia. e 2 354 153
6145; 616 Other disorders of menstruation and the

menopause Zs : e 3 . 127 55
615 Sterility a e 2 a 48 21
617 Diseases of vulva and vagina ; 5. 2 192 83
618 Bartholin’s glands . ‘ 68 30
619 Other diseases of female ‘genital organs a 35 15

Totals 2 2 . 3 . 4 2,312 1,000

The proportionate distribution of diseases of the female genitalia is
shown in Table 60. Of every 1,000 admissions, 465 were due to disorders
of menstruation and menopausal symptoms. The frequency and disab-
ling nature of these conditions is emphasised by figures from the
Survey of Sickness, which show that for the period May 1946-April
1947 the monthly inception rate* for this cause was 1,902 per 100,000
women aged 16 and more, and the monthly prevalence rate* was
3,041 per 100,000 (Stocks 1949). Further, 21 per cent. of these illnesses
caused either at least one day of incapacity or at least one medical
consultation. About 1,800 Service women were admitted for treatment
of cervicitis during the eight years.

Table 61 shows the estimated numbers who were treated in E.M.S.
hospitals for normal and abnormal childbearing. Since many Service
women would seek discharge from the Forces on grounds of pregnancy,
and their subsequent history is unknown, these figures may not show
a correct ratio of abnormal to normal cases of childbearing. Mackay
(1951) has shown that in a sample of hospital discharges, out of 19,800
attributed to pregnancy, childbirth and the puerperium, 11,364 were

* See p. 666 for definitions.

712, CASUALTIES AND MEDICAL STATISTICS

TABLE 61

Normal and Abnormal Childbearing. Numbers in sample and estimated
total admissions, 1940-47

M.R.C. Total Estimated Pro-
Code Diagnoses Numbers total portions
Number (Sample) | admissions
620 Normal pregnancy . , . 117 585 + 54 rr
650 Normal delivery . : Q 3r 15+ 28 29
621-638 Abnormal pregnancy. ’ 11 555 + 53 105
640-646 Abortion, therapeutic or other,
with or without sepsis. 784 3,920 + 140 742
651-679 Abnormal delivery and com-
plications of puerperium. 14 jot 19 13
620-679 Totals is 5 A : 1,057 5,285 + 163 1,000

due to normal or unqualified childbearing and 8,436 to abnormal, or
57 per cent. and 43 per cent. respectively, but presumably admission
to hospital was facilitated if abnormality were recognised or suspected.

OTHER GENITO-URINARY DISEASES (Short List Number 31)

This group comprises diseases of the urinary system and of the male
genital organs. They contributed from 4 to 5 per cent. of the basic
total of admissions of men and from 2 to 5 per cent. of women (Table
62). These relatively small proportions may be due to the elimination
of persons with some forms of kidney disease at the preliminary medical
boards. The rates showed no pattern of variation with age except that
they were generally lower at ages 15-24 than at 25-34 for both sexes.

TABLE 62

Diseases of the Urinary System and Male Genital Organs
Proportions per 1,000 Admissions for Non-infective and Non-respiratory
Illnesses, by Sex and Age, 1940-47

THE EMERGENCY MEDICAL SERVICES = 713

If diseases of the male genitalia be excluded, the proportional com-
position of admissions for urinary conditions is shown in Table 63.
In each year the principal components among men were pyelitis,
cystitis and calculi of kidney and ureter, whereas among women pyelitis
and cystitis were the principal contributors to the total of urinary
diseases. Calculi, which caused 21 per cent. of men’s admissions in
this disease group accounted for only 6 per cent. of those of women.

TABLE 63
Proportional Composition of Admissions for Diseases of the
Urinary System (M.R.C. Code 560-588) by Sex, 1940-47

M.R.C. Males Females
ie DIAGNOSES
No. 1940 | 1941 | 1942 | 1943 | 1944 | 1945 |1946-7| 1940-45 | 1946-47
Acute nephritis . 4 63 37 5° 92 89 104 7° 20

60
61-566 | Other forms of

nephritis 5 82 82] 121 98 | 106] 174] 176] 117 34
$70 Pyelitis, pyelone-
phrius,
c Pyelocystitis 166 aor | 218 199 169 107 18 172 $34
574 ystitis ‘ 5 | 191 | 204] 23! 187 | 240] 1 2 290
875 Calculi of kidney
and ureter. 286 | 198 195 170 | 207] 192] 256 | 207 59
4!

The age distribution for men of cases of acute nephritis, other forms of
nephritis, pyelitis, cystitis and calculi is as follows:

1s- 25- 35-45-55 up All ages

Acute nephritis 44 41 13 2 _ 100
Other forms of nephritis 32 45 20 3 _ 100
Pyelitis 29 48 20 2 I 100
Cystitis 31 45 19 4 1 100
Calculi of kidney and ureter 23 51 24 2 _ 100
TABLE 64
Proportional Composition of Admissions for Diseases of the
Male Genital Organs, 1940-47, and Estimated Total Admissions
7
M.R.C. Total Estimated Pro-
Code Diagnoses Numbers total portions
Number (Sample) i admissions
590-591 Diseases of the prostate . i 1130! 565+ 53 30
592 Hydrocele_ . : é i 814 | 4,070 + 143 218
593-594 Haematocele and spermatocele SJ sl 285 + 38 15
595 Orchitis and epididymitis ; 1115 | 5,575 + 167 | 299
596 Torsion of testis or spermatic '
cord . ’ : ° 22 110 + 23 6
597 Paraphimosis and phimosis . 1,411 | 7,055 + 188 | 379
598 Other diseases of male genital
organs. if ‘ f 198 990+ 70 53
Totals F 2 2 3,730 | 18,650 + 305 | 1,000

714 CASUALTIES AND MEDICAL STATISTICS

Acute nephritis caused more hospitalisation among younger men
than did the chronic and unspecified forms of this disease, while the
other three conditions appeared more frequently in the older men than
among those aged 15-24.

It is estimated that about 18,500 men were admitted with a primary
diagnosis of disease of the genital organs. Of these roughly 7,000 were
treated for phimosis and paraphimosis and 5,500 for orchitis and
epididymitis.

DISEASES OF SKIN AND CELLULAR TISSUE (Short List Number 34)
Diseases of the skin and cellular tissue were responsible for a large
proportion of the basic total of admissions, the rates for men of all ages
varying between 15 and 19 per cent. and for women from g to 11 per
cent. Table 65 shows that the proportionate rates for men decreased

TABLE 65

Diseases of Skin and Cellular Tissue. Proportion per 1,000 Admissions
Sor Non-infective and Non-respiratory Illnesses, by Sex and Age, 1940-47

with age, except in 1944. At ages 15-24 admissions for this disease
group constituted about one-fifth of the basic total, and at ages 25-34
about one-seventh. While not serious from the point of view of endan-
gering life, these diseases were responsible for a considerable amount of
ill-health, and although under civilian conditions the numbers sent to
hospital on this account would not be so great as in the sample under
review, a considerable amount of incapacity would nevertheless be
caused.

Table 66 shows the proportions in which individual skin discases
were represented in the total admissions coded to M.R.C. numbers
680-699. Cellulitis and acute abscess (other than of finger and nail-bed)
showed consistently high rates during the eight years, both for men and
women. The rate for impetigo, which in 1940 was the most important

THE EMERGENCY MEDICAL SERVICES 715

TABLE 66

Diseases of Skin and Cellular Tissue. Proportionate Composition of
Admissions by Sex, 1940-47

M.R.C. | Males Females

Code DISEASES
No. 1940 | 1941 | 1942 | 1943 | 1944 | 1945 1947 |1940-47 |1940-47
680 | Carbuncles and
a i 126 131 139 | Ist tss | 148 1s2 |] 142 143
1
ee 73 or] ro} 144} 163] 132 163 | 120 223
2
abscess. . 212 | 191 | 206] 233 | 239 | 240 318 oe 218
683 | Sycosis barbae | 23 22 6 12 18 19 10 ry ae
684 Impetigo. 2a 202 179 124 88 82 65 146 8
685 Chronic ulcer ‘ 19 22 17 24 24 2 5 ar 1
686 Other local skin
infections . 26 27 17 19 14 20 26 20 9
687 | Acne vulgaris : 11 ir 13 10 ro} 12 26 12 7
688-9 Contact dermatitis,
drug rash . 6 5 1 8 16 21 16 ar 14
690 Pruritus, etc. ‘6 4 6 8 10 7 8 3 7 ra
691 Erythematous
conditions ‘ 6 5 5 § 6 4 =, Ss 1
6920 Eczema a 49 54 59 4 52 $2 23 52 go
6921 Seborrhoeic
dermatitis . A 33 42 4° 37 48 74 60 23 45 oi)
693 Psoriasis . " 32 29 25 a2 24 22 16 s 25 35
694-5 | Lichen planus and
Pemphigus * 4 2 2 4 2 5 1 5 a 4
696 | Hypertrophy and
atrophy of skin . 8 8 9 7 5 8 7 5 8 12
6970-3 | Diseases of hair. ar 9 10 3 5 5 6) — 7 4
6974 | Diseases of sweat
glands a 22 33 33 34 33 29 38 4 32 23
6975 | Diseases of y 42 6 44 4r 29 5 45 728 O 37
698-9 | Other skin diseases 4 8] 72] 53 67 1 39 | 36 4 34
680-699) Totals + | 1,000 | 1,000 | 1,000 | 1,000 [1,000 | 1,000 | 1,000 | 1,000 | 1,000 1,000

single cause in this group, declined steadily from 221 in that year to
65 in 1946 and 1947. For women, many of whom would be engaged
in preparing or serving food, cellulitis of finger and nail-bed showed
the highest proportionate rate. Similar high rates obtained for carbuncles
and boils. The percentages of carbuncles and boils which appeared
on the head and neck were, males 38 per cent.; females 55 per cent.
The percentage distribution of cellulitis and acute abscess by site for
the two sexes was as follows:

Head Other
Sex and | Trunk} Arm | Hand| Leg | Foot | Male and Totals
Neck Genitals | Unspec.
Males . 17 10 I 22 17 20 1 2 100
Females. 22 19 8 13 14 23 _ 1 100

Examination of the numbers of admissions in 13-weekly periods for
non-mycotic sycosis barbae and impetigo (Table 67) showed little
seasonal variation except that the total admissions for impetigo in the

716 CASUALTIES AND MEDICAL STATISTICS

TABLE 67

Quarterly Admissions for Sycosis Barbae (M.R.C. Code 683) and
Impetigo (M.R.C. Code 684) Persons, 1940-45

Season

No.

1st Qtr.

683 Sycosis barbae 19
(non-mycotic) | 2nd Qtr. 20

grd Qtr. 19

4th Qtr. 9

684 Impetigo 1st Qtr. 87
and Qtr. 83

3rd Qtr. 80

4th Qtr. 66

second and third quarters were rather less than those for the two winter
quarters.

From Table 68 it is apparent that the median period of in-patient
treatment for impetigo varied, for men aged 15-34, between 18 and
22 days, the median taken over the seven years 1940-46 being 20 days.
Twenty seven per cent. of men in this age group were in hospital for
less than 10 days, 41 per cent. from 14-27 days and 32 per cent. for
28 days or more. The median duration of stay for men aged 35-54
was 18 days, 29 per cent. being treated for less than 14 days, 40 per cent.
from 14-27 days and 31 per cent. for 28 days or more. The median stay
for women aged 15-34 was 15 days. The total number of days of
incapacity due to impetigo alone in the 1 in 5 sample was 78,685 for
men aged 15-34; 6,681 days for men aged 35-54, and 2,776 days for
women aged 15-34. The mean periods in hospital for these three
groups were 26, 27 and 19 days respectively.

Of persons admitted with a disease of the skin or cellular tissue
assignable to M.R.C. code numbers 68 or 69 as primary diagnosis,
7°3 per cent. also suffered from a second condition in the same group,
which was either present on admission or developed during the stay in
hospital. The frequency with which such pairs of skin conditions
occurred is shown in Table 69. Thus 35 people who suffered from
eczema also had carbuncles or boils, while 59 who had impetigo also had
cellulitis or acute abscess.

DISEASES OF BONES, JOINTS AND MUSCLES (Short List Number 35)

This group comprises the conditions shown in M.R.C. Code numbers
7x and 72. They caused from 5-3 to 7-5 per cent. of the basic total of
men’s admissions and from 1-7 to 5°7 of women’s. From 1940-45
the proportionate rates for men aged 25-34 were higher than at ages
15-24, and from 1940-44 they then decreased with age. For women also

77

THE EMERGENCY MEDICAL SERVICES

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718 CASUALTIES AND MEDICAL STATISTICS

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THE EMERGENCY MEDICAL SERVICES 719

the proportionate rates at ages 25-34 were higher than those at ages
15-24 throughout the eight years under consideration. This may be in
some measure due to older people who were unused to physical exertion
of a strenuous nature and whose bodies were less supple being re-
introduced to physical training and organised games. Internal derange-
ment of the knee joint, which was commonly attributed to one or other
of these pastimes, was the primary cause of admission of 3,890 men and
69 women in the sample, corresponding to estimated admissions of
about 19,500 men and 350 women. Bursitis and synovitis were respon-
sible for estimated admissions of around 12,000 men and 800 women.
Flat foot, hallux valgus and hallux rigidus, conditions which had perhaps
been tolerated in civilian life, are calculated to have caused about 6,000
admissions of men and 650 of women.

TABLE 70

Diseases of Bones, Joints amd Muscles (Non-rheumatic).
Proportion per 1,000 Admissions for Non-infective and Non-respiratory
Illnesses, by Sex and Age, 1940-47

Males Females

Year Age Groups Age Groups

15- | 25- |] 35- | 45- | 55 up| All | r5- | 25- | 35- | 45 up| All

The proportionate age distribution of men admitted with osteomy-
elitis, acute infective arthritis, bursitis and synovitis, curvature of the
spine or flat foot is as follows:

M.R.C. Age Groups

Code Diseases

No. 1s- | 25- | 35- | 45- |55 up| All
710, 711 Osteomyelitis . ! es 44 38 I4 3 I 100
715 Acute infective arthritis . 30 46 19 5 _ 100
718 Bursitis and synovitis 2 39 44 15 2 ° 100
725 Curvature of spine : 34 39 25 2 _ 100
727 Flat foot 3 . : 32 45 21 2 — 100

The proportion of cases of osteomyelitis was higher in the age group
15-24, whereas in the other four conditions the greatest number of
cases occurred at ages 25-34.

qzo CASUALTIES AND MEDICAL STATISTICS

The M.R.C. code number 729 includes such conditions as bunion,
coxa valga or vara, hammer toe and pes cavus. In the 1 in 5 sample
1,348 admissions were assigned to this number. Of these 551 were for
hammer toe, the mean stay in hospital for this condition unaccompanied
by any complication or concurrent disease being 65 days. There were
also 25 cases of cervical rib, with mean duration of 67 days. Three
hundred and fifty people in the sample were admitted for treatment of
deformities due to previous injuries or diseases.

Sixty-four people were admitted for foot strain, with mean stay of
33 days. The Lancet (1942) in a leading article entitled ‘Soldier’s Foot’
comments that ‘there are three periods at which pain denoting strain
may arise—on enlistment, at physical training and on route marching’.
Early recourse to an orthopaedic surgeon is recommended, as otherwise
deformities may develop requiring treatment in hospital of from 6-8
weeks. “The war has shown that a painful foot is a major disability
requiring in-patient treatment as out-patient supervision is usually
incomplete.’

Another pathological condition brought to notice by Service con-
ditions was that called variously march, fatigue or stress fracture. This
is most commonly a break of the second or third metatarsal bone,
proximal to the neck, but it may also occur in the upper third of the
tibia, though it is uncommon in other sites. Such fractures occur
without trauma and may only give rise to slight symptoms such as an
aching foot after marching or pain and swelling in the leg. Annan

TABLE 71
Admissions with a Primary Diagnosis of Stress or Fatigue Fracture, 1940-47

Diagnosis Site of fracture

March fracture M
March fracture M
March fracture M
Fatigue fracture M
Fatigue fracture | 2nd R. metatarsal . M
Fatigue fracture | R. tibia ‘ M
Fatigue fracture | R. tibia M
Fatigue fracture | R. tibia M
Fatigue fracture | R. tibia M
Fatigue fracture | R. tibia M
Stress fracture R. tibia M
Fatigue fracture | R. tibia M
Fatigue fracture | R. tibia M
Fatigue fracture | L. tibia M
Fatigue fracture | L. tibia M
Fatigue fracture | L. tibia M
Fatigue fracture | L. tibia M
Stress fracture R. fibula M
March fracture | Not stated M
Fatigue fracture M

THE EMERGENCY MEDICAL SERVICES 721

(1945) reports 8 cases of shoveller’s fracture from a Prisoner-of-War
camp in Germany. This is a fracture of thespinous processes of cervical
and dorsal vertebrae. He points out that an interesting feature was the
premonitory pain in the back present in some cases for a few hours or
days before the click in the neck which could be considered to mark the
breaking of the bone. No cases of shoveller’s fracture were found in
this series, but there were in the sample 20 cases described as march
fracture or its synonyms; details of these are set out in Table 71.

CONGENITAL MALFORMATIONS (Short List Number 36)

The total number of admissions attributed to this cause in the sample
was 768 for men and 51 for women. Their proportionate distribution
for men was as follows:

M.R.C. No. Disease
736-739 Hare lip, cleft palate, congenital pyloric stenosis,
imperforate anus and other abnormalities of the digestive
system... - 4. «29 per cent.
741 Undescended testicle : . 25 per cent.
740; 742 Cystic disease of the kidney and other abnormalities of
the genito-urinary system z - 8 per cent.
743 Clubfoot, congenital deformities of spine, dislocation
of hip and other malformations of bones and joints
13 per cent.
Rest of
730-745 Other congenital malformations. + 25 per cent.

ILL-DEFINED SYMPTOMS (Short List Number 37)

This group, comprising numbers 7600 to 7691 of the M.R.C. code,
contains a number of recognised conditions and vague symptoms which
may constitute in themselves minor illnesses or may be merely sympto-
matic of some graver condition as yet either undetected or not manifest.
Headache for example may be in itself a minor ailment, perhaps
indicating a low state of health or general ‘nerviness’ or it may be a
symptom of hypertension. Similarly praecordial pain and cough can
be minor illnesses or they may indicate, among other things, coronary
thrombosis and cancer of the lung respectively.

A cause of admission would only be assigned to one of these numbers
when:

(a) No more definite diagnosis could be made, no matter what

examinations or tests are applied.

(b) The symptom cleared up without a more serious underlying

condition being detected.

(c) The patient’s discharge occurred before a more definite diagnosis

could be made.

722, CASUALTIES AND MEDICAL STATISTICS

It was therefore to be expected that admissions coded to symptoms
in M.R.C. group 76 would form a very small proportion of the total
of admissions. Table 72 shows that in the present series men’s admis-
sions for this cause varied, at all ages, between 2-3 and 5 per cent. of
the basic total, and women’s between 2-8 and 7-0 per cent.

TABLE 72
Ill-defined Symptoms (except Jaundice) Proportion per 1,000 Admissions
for Non-infective and Non-respiratory Illnesses, by Sex and Age, 1940-47

Males

Age Groups

The proportional rates in the various decennial groups were high for
both sexes in 1942 compared with the other years, this being due in
greater part to the increased numbers of admissions of both sexes in
that year for headache, pain in the chest and abdominal pain, and in the
case of women, for diarrhoea. The rates are higher than the average for
men aged 55 and over, since in older men such symptoms are more
likely to indicate the onset of a serious malady and therefore require
hospital investigation.

The fourteen symptoms to which were attributed the highest numbers
of admissions, together with the estimated numbers of men with these
as primary diagnosis were as follows:

Abdominal pain 4,150 + 144 Pain in the back 1,050 + 72
Diarrhoea 3,060 + 124 Syncope 1,015 + 7%
Headache 1,660 + 91 Epistaxis 8g0 + 67
Pyrexia 1,290 + 80 Haemoptysis 835 + 65
Pain in the chest 1,245 + 79 Haematemesis 810 + 64
Haematuria 1,120 + 75 Debility 805 + 63
Frequency 1,065 + 73 Vertigo 650 + 59

That patients with symptomatic diagnoses may nevertheless take up
hospital beds for a considerable amount of time is indicated by Table 73,
which shows the distribution of days in hospital for eight selected
symptoms. The median duration of stay for men with depression was
about 8 weeks, while for the remaining conditions it mostly varied
between 1} and 2} weeks.

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733

THE EMERGENCY MEDICAL SERVICES

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734 CASUALTIES AND MEDICAL STATISTICS

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THE EMERGENCY MEDICAL SERVICES

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736 CASUALTIES AND MEDICAL STATISTICS

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737

THE EMERGENCY MEDICAL SERVICES

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738 CASUALTIES AND MEDICAL STATISTICS

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739

THE EMERGENCY MEDICAL SERVICES

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740 CASUALTIES AND MEDICAL STATISTICS

Admissions for Injuries

In the M.R.C. Classification injuries and acute poisoning are con-
sidered from three angles. The three- or four-figure numbers from
800-949 are used to show the nature of the injury, e.g. fracture, dis-
location, shock, burns, poisoning, etc., the classification being so devised
as to distinguish, for local injuries, the part of the body affected. The
external cause of the injury is denoted by a suffix, thirty possible
numbers being assigned as follows:

Railway accident

Driver of motor cycle injured on road

Driver of other motor vehicle injured on road

Passenger or unspecified occupant of motor vehicle

Pedestrian injured by motor vehicle

Other or unspecified motor vehicle accident on road, including
pedal cyclist injured by motor vehicle

Pedal cyclist injured on road (not by rail or motor vehicle)

Other or unspecified road transport accident

Water transport accident

9 Air transport accident (including glider and parachute accident)

CONT NN MP wWN HO

oV Accident in mine or quarry

1V_ Agricultural accident

2V Machinery accident (not included above)

3V_ Conflagration

4V_ Bomb injury (including mines, grenades, depth charges and
effects of blast)

5V Gunshot injury (including rifle, machine gun and small arms)

6V Other explosive missiles (including mortar, cannon, breech-

block weapon burst) and shrapnel (not further defined)

7V Cutting or piercing injuries

8V_ Cataclysm

gV_ Injury by animals

oX Fall

1X Crushing, landslide injury

2X Blow

3X Explosion injury (not included elsewhere)

4X Accident during sport

5X Other or unspecified cause of injury in the home
6X Other or unspecified cause of injury at work

7X Other or unspecified cause of injury elsewhere

8X Other cause of injury in unspecified locality

gX Unspecified cause of injury in unspecified locality.

THE EMERGENCY MEDICAL SERVICES — 741

Definitions of these terms may be found on pages 136-41 of the
M.R.C. Classification. Broadly speaking, a transport accident for
example may be taken to be any accident occurring on or from the type
of vehicle involved. Thus a railway accident is any injury (or poisoning)
from any cause happening on a railway, or on a tramway where the
car was circulating outside a town on its own track, except collisions
with motor vehicles. While the M.R.C. Classification worked well for
analysing accidents to Service personnel and such types of injuries to
civilians as entitled them to treatment in E.M.S. hospitals, nevertheless
experience has shown that for making a detailed analysis of external
causes of injury it is necessary to define more precisely the terms
involved. Railway passenger, goods transport motor vehicle, public
highway and pedestrian are examples of such terms calling for careful
definition if comparability between statistics is to be obtained, a fact
which has been fully recognised in the Sixth Revision of the Inter-
national Lists of Diseases and Causes of Death.

The third aspect considered in the M.R.C. Classification, that of
responsibility for the accident, is denoted by a prefix:

VX Injury to non-civilian resulting directly from enemy action,

including late effects of such action

VV _ Injury to civilian directly due to operations of war, including

home-guard or fire-guard practices but not other accidents
while on civil defence duties unless during enemy operations
V_ Self-inflicted injury
X Injury inflicted intentionally by another person, not in warfare.

No prefix was assigned to injuries which were purely accidental.

In many cases more than one injury was recorded, particularly in
aircraft accidents where burns might accompany fractures and bruising
or in gunshot injuries where a fracture in one limb might be accom-
panied by an open wound of another site. In order that the selection of
the principal cause of admission should not be left to the choice of the
individual coder, a rule was made for selecting as principal cause that
injury which is highest in the following list:

Suffocation or immersion M.R.C. Code 940, 941
Acute poisoning 900-924
Traumatic amputations 817-818
Head injuries 800
Fractures 840-845
Dislocations 846
Burns 930-936
Other effects Rest of 80-94

Certain code numbers among 80-94 were more commonly used for
secondary than for primary coding; thus foreign bodies (812-814)

742, CASUALTIES AND MEDICAL STATISTICS

were usually recorded in space II on the record card, i.e. as complica-
tions of an open wound recorded as the principle cause of admission
in space I. Nerve injuries (82-83) were frequently secondary to fractures.
Similarly, conditions assignable to numbers 85-89 might appear in II if
related to the primary injury recorded in I. Two other titles, therapeutic
misadventures (95) and late complications of therapeutic procedures
(96) are only used for primary coding if they occur before admission
to hospital, otherwise they are coded as complications.

During the seven years 1940-46, the estimated total number of
admissions for injuries and poisoning was 290,000 males and 12,000
females. The ratio of yearly admissions to the 1,000 basic total of
admissions is shown in Table 74.

TABLE 74

All Injuries. Ratio per 1,000 Admissions for Non-infective and Non-
respiratory Illnesses by Sex and Age, 1940-47 (Service Cases)

Females

Age Groups

In 1941 the proportionate rates were lower for males in each age group
and at all ages than in 1940. At ages under 45 the rates rose to a peak in
1944 when the Second Front in Europe was opened. A decrease
followed in 1945 and 1946, but in 1947 the rates in each age group and
at all ages were higher than in the previous year, largely due to the
return of Service men and prisoners-of-war from the Far East with
injuries which required further hospital treatment or stumps which
needed treatment prior to limb-fitting. From 1940 to 1946, at ages
under 44, the proportional rates for men decreased with age. In 1944,
admissions for injuries at ages 15-24 and 25-34 formed 37 per cent. and
35 per cent. of the total admissions for all causes in those age groups,
whereas in 1941, when the proportional rates were lowest, they had
formed 17 per cent. and 15 per cent. respectively. Proportional rates
for women of all ages increased from 92 in 1940 to 134 in 1942, then
declined to 76 in 1945, following which there was a rise to 110 in 1946.

THE EMERGENCY MEDICAL SERVICES = 743

HEAD INJURIES (Short List Number 38)

This Short List number includes fractures of the skull (M.R.C.
numbers 8400-9) but excludes fractures of skull with fractures of other
sites (M.R.C. 8450-1). Table 75 shows the proportionate rates of
admission for head injuries.

TABLE 75

Head Injuries. Ratio per 1,000 Admissions for Non-infective and
Non-respiratory Illnesses by Sex and Age. 1940-1947 (Service Cases)

Males

Females

Age Groups Age Groups

Year

ts- | 25- |35-44] All

1940 22 51 28
1941 39 28 34 25 28
1942 42 23 27 18 23
1943 40 21 22 11 20
1944 58 19 17 22 19
1945 30 12 6 16 baa
1946 4° 19 32 _ 21

14 30

In the sample 7,161 men and 417 women were admitted with head
injuries during the eight years 1940-47, corresponding to about 36,000
men and 2,000 women actually admitted. During 1940-46 the propor-
tionate rates for males declined with age up to 45 years. Among females
the rates were higher at ages 25-34 than at 15-24, except in 1944 and
1945. The increase in head injuries in 1944 over the previous years for
men aged 15-34 was less pronounced than for all injuries.

Of admissions other than for fracture it will be seen from Table 76
that concussion accounted for 53 per cent. of the men and 59 per cent. of

TABLE 76
Proportionate Distribution of Types of Head Injury, by Sex. 1940-47
M.R.C, Disease Group Males | Females | M.R.C. Disease Group Males | Females
Code Code
8000 Open wounds of 8400 Fracture, vault of
scalp 346 258 skull 122 110
8001 Bruising, contusion 840r Fracture, base of
of scalp 35 69 skull 96 171
8002-4 | Extradural, subdural 8402-3 | Fracture, sinuses
and Subarachnoid 4 6 and orbit 59 146
Haemorrhage 8404 | Fracture, nasal
8005 Cerebral laceration 4 18 bones 226 207
8006 | Concussion 533 soz | 8405 | Fracture, maxilla,
8007-8 | Intracranial zygoma, malar 114 61
haemorrhage and 8406 Fracture, lower jaw 224 122
other sequelae 43 24 | 8407-8 | Fracture, ill-
8009 | Head injury, defined, face or
unspecified 25 33 skull 77: 73
8409 | Multiple fractures
of skull 82 110
Totals 1,000 1,000 Totals 1,000 1,000

744 CASUALTIES AND MEDICAL STATISTICS

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746 CASUALTIES AND MEDICAL STATISTICS

the women, while a further 35 per cent. and 26 per cent. respectively
had open wounds of the scalp. Men were more prone to fracture the
vault than the base of the skull, the reverse being true for women.
Nearly a quarter of all fractures of skull bones among men were of the
nasal bones, the corresponding proportion for women being about
one-fifth. For both sexes, fractures of the lower jaw were about twice
as common as those of the upper jaw bones. It is estimated that about
8,500 men and 430 women were admitted for open wounds of the
scalp, and 13,200 men and 990 women for concussion. Whereas women’s
admissions for head injuries, other than fractures, were 6-4 per cent. of
the total admissions, for fracture of the skull bones they were only
3:6 per cent. of the total admissions.

Table 77 shows the distribution of days of in-patient treatment and
the median number of days in hospital for certain types of head injury.
The median period of treatment of scalp wounds was 10 to 11 days for
men and a week for women. For concussion the median period for
younger men varied in different years between 15 and 26 days, while
over the seven years 1940-46 it was 18 days. For older men the median
was 13 days and for women 14 days. Rather more than 32 per cent. of
the younger men were treated for 28 days or more, the corresponding
proportions of older men and women being 9 per cent. and 18 per cent.
Fractures of the vault of the skull in this series required an average of
32 days in hospital, compared with 22 days for fractures of the base.
The median period of treatment for fractures of the nasal bones was
10-11 days for men and 6 days for women. Of 255 men aged 15-34
admitted for this disability, 30 per cent. were in hospital for less than
4 days. Fractures of the lower jaw bone necessitated 56 days median
duration of in-patient treatment among men of 15-34 years and 38 days
for those aged 35-54. Twenty-eight per cent. of the younger men were
in hospital for periods of three months or over.

The record cards of 2,179 persons of both sexes admitted during
1942-46, primarily for head injuries, but with one or more other
conditions recorded, were examined; 1,484 had primary diagnoses
assigned to M.R.C. numbers 8000-8009 and 695 had fractures of the
skull in 8400-8409. These cases form a large proportion of admissions
with multiple causes; some cases which came in late are not included.
The complications and accessory acute conditions shown in Table 78
are those which might be assumed to be related to the primary diagnosis
of head injury.

747

THE EMERGENCY MEDICAL SERVICES

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748 CASUALTIES AND MEDICAL STATISTICS

FRACTURES, OTHER THAN SKULL (Short List Number 39)

In the one in five sample, 19,465 men and 646 women were admitted
with a primary diagnosis of fracture other than of skull bones only;
the corresponding estimated total of admissions was around 97,000
men and 3,200 women. The proportionate representation of the chief
sites in every 1,000 fractures was as follows:

Spinal Trunk Upper Lower | Multiple Totals
Column (except Limb Limb Sites
Spine)
Males 35 47 320 494 104 1,000
Females 39 39 363 514 45 1,000

There was little difference between the sexes as regards spinal fractures,
but men showed a higher proportion of fractures of trunk bones of
multiple sites, while women had a higher proportion of fractures of
either upper or lower limbs. The very much higher proportion of
fractures of multiple sites among men is due in part to their greater
exposure to injury by high explosives, especially shrapnel.

‘TABLE 79

Fractures, other than Skull. Ratio per 1,000 Admissions for Non-infective
and Non-respiratory Illnesses, by Sex and Age, 1940-1947

Males

Age Groups

It will be seen from Table 79 that for men the ratio of the number of
admissions for fractures to the basic total of admissions was 8-6 per
cent. in 1940 and 1941, rising to 20 per cent. in 1944 and declining to
8-6 per cent. in 1946. The subsequent increase to 11-4 per cent. in
1947 was due to admissions of returned prisoners-of-war and casualties
from the Far East. This pattern of increasing rates up to 1944, a
decrease in 1945-46 followed by a further increase in 1947 is observable
for each age group under 45 years. During 1941-46 the proportionate

THE EMERGENCY MEDICAL SERVICES 749

rate for fractures decreased with age in the three groups under 45
years. Among women, fractures formed from 2 to 3-4 of the basic
total of admissions, and there was little variation from this level in the
two age groups under 35.

(a) Fractures and Fracture-Dislocations of the Vertebral Column

Admissions for fracture of the vertebral column during 1940-46 were
711 in the sample, or about 3,500 estimated total admissions, of which 96
per cent. were male cases. The M.R.C. Classification distinguishes
four groups of vertebrae, 7 cervical, 12 thoracic, 5 lumbar and the
sacral process, and separate code numbers are assigned to distinguish
cases in which the fracture was accompanied by an injury to the spinal
cord. In coding, where the fracture involved vertebrae in two or more
of these groups, as for instance the frequent combination of twelth
thoracic and first lumbar, the assignment was to the group first men-
tioned above.

TABLE 80

Proportionate Composition of Admissions for Fractures of
Vertical Column. (Sexes combined, 1940-46)

Part of Vertebral 1940 | 1941 | 1942 | 1943 | 1944 1945-6 1940-46
Column Injured
Cervical spine . - 10 13 10 9 12 12 W
‘Thoracic spine 5 13 ot 15 21 27 29 20
Lumbar spine . Z 60 65 61 57 49 46 55
Sacral spine or coccyx 15 8 10 9 10 7 10
Vertebral column,
ill-defined. 7 3 3 4 4 2 6 4
Vertebral column
(all parts)

Table 80 shows the proportionate distribution of fractures among the
four regions, the numbers for males and females being combined
because of the small proportion of females with this type of injury.
During the seven years, over half the total spinal fractures were in the
lumbar region, one-fifth in the thoracic, one-tenth each in the cervical
and sacral regions, while in 4 per cent. the exact position in the spine in
which the injury occurred was not defined.

The proportion of fractures in which there was mention of injury to
the spinal cord is shown in Table 81. Rather less than a quarter of the
fractures of the cervical spine were accompanied by damage to the
cord, 30 per cent. of those in the thoracic region and less than one-tenth
of those in the lumbar region. For all parts of the vertebral column there
was damage to the cord in 15 per cent. of the cases. The years 1944-45,

750 CASUALTIES AND MEDICAL STATISTICS

‘TABLE 81

Percentage of Spinal Fractures with mention of Spinal Cord Lesion
(Sexes combined, 1940-46)

Part of Vertebral 1942 | 1943 | 1944
Column Injured % % % % %
Cervical spine . : 33
Thoracic spine 44
Lumbar spine . 4 16
Sacral spine. 7 6
Vertebral column,
ill-defined. ‘ 5°

Vertebral column
(all parts) . 3 25

when many injuries were received in fighting on the Second Front,
show the highest percentages of fractures with spinal cord lesion, due
to the greater frequency of gunshot and shrapnel wounds penetrating
into the spinal canal.

More detailed information about spinal cord injuries was obtained
by examining the case records of 256 Service men and women who
had applied for War Pensions on the grounds of incapacity due to
damage to the vertebral column. For its own statistical purposes the
Ministry of Pensions prepares a record sheet relating to each new
applicant, showing the nature of the disability on which the claim is
based. By searching these sheets for records of cases with spinal cord
involvement it is possible to refer back to the original medical documents.
As cases are reviewed periodically for assessment of the amount of
residual disability, it is possible to follow up the medical history for a
considerable time. The disadvantage of this survey is that, since the
injuries occurred in different years but the investigation had to be
completed in one operation, the ‘follow-ups’ extend over varying
periods of time. Nevertheless the following tables are presented,
subject to the condition that rigorous conclusions should not be drawn
from them.

The region of the spine in which the fracture had occurred in the
256 cases examined was:

Cervical | Thoracic | Lumbar Sacral | Not stated| Totals

Numbers 70 256
Percentage 27 100

The over-all figures of cases who had survived up to the time of the
last examination are as follows:

THE EMERGENCY MEDICAL SERVICES — 751

Cervical | Thoracic Sacral | Notstated} Totals
Cases 35 130 256
Survivors 34 83 199
Percentage
Surviving 97 64 77

The percentage of cases with thoracic injury who survived is signifi-
cantly lower than that for injury to either the cervical or lumbar
vertebrae, the differences being 33 + 10-2 and 23 + 11-6 respectively,
whereas the difference between the percentages surviving with cervical
or lumbar injury is 10 + 9-8. Table 82 shows, in six monthly intervals,
the period between date of injury and either the date of death
or the last date for which information was recorded; the latter
would in general be the date of the last Medical Board prior to the
survey under discussion. Thus, of persons with injury in the thoracic

region who were last examined at a period of 2 years but less than 2

TABLE 82

Spinal Cord Injury. Period between date of injury and last date for which
information recorded, or date of death.

Site of Period in Months

Spinal | Survived

Fracture | or Died | o- | 6- | 12- | 18- | 24- | 30- | 36- | 42- | 48- | 54- | 60- | 66-71) All
Cervical | Survived] —}] 1 | 2 3 3 8 5 3 2 1 5 r | 34
ied —|{ 1 - _- 1

Thoracic | Survived} 3 | — 3 u 20 Wu 18 4 6 1 2 1 83
Died. 3) 14] 12 7 5 4 1 1 _ _- _— _ 7

Lumbar | Survived | 1 1 3 xt 10 uw 7. 10 8 3 rz = 1
Died z/—| 4/— aj/—|— 1 r{/—{—]|—]o0

Sacral Survived -|- 2 2

Died _ = =

Not stated] Survived | — ] 1 3 4 3 2 3 1 2 _- 19
Died -|-|—- - =

years 6 months from the date of injury, 20 were alive at the time of
examination whereas 5 had died. Forty-nine of the 57 who died were
paralysed at the time of death and of those who had survived some
were completely paralysed in the lower limbs with little or no control
over the urinary system at the time of the last examination recorded.
The numbers of such cases, distributed according to the period between
injury and either death or last date of examination, are shown in Table 83.

Deaths occurring in this group of paraplegics, while having as
underlying cause the initial spinal injury, fall mainly into two groups as
regards secondary causes; those due to pyelonephritis and other
disorders of the urinary tract, and those due to septicaemia from
infected bedsores. Of the 57 deaths in this series, two were not stated
to be due to the fracture of the spine, one being due to an anaesthetic
misadventure during tooth extraction and the other to pulmonary
tuberculosis. A further nine deaths were assigned to ‘war operations’,

752 CASUALTIES AND MEDICAL STATISTICS

TABLE 83
Spinal Cord Injury. Cases with Total Paralysis at last recorded date or at death
Site of | Survived Period since Injury (Months)
Spinal | or Died
Injury o- | 6 | 12- | 18- | 24- | 30- | 36- | 42- | 48- | 54- | 60- | 66-71] All
Cervical | Survived | — 1 air t 1 2 = 1 ead — — = 6
Died —j|—-| -|] -]| - -
Thoracic} Survived] 3 | —| 2 3 | + 5 ol 4 3 1 1 — jas
ied 3 | 12 | 12 3 2 1 1 pal) Nees Hie) (ieee ber)
Lumbar | Survived | — 1 = 1 4 4 3 2 I ve - Ps 16
ied 1 4 1 t _- _ 7
Sacral Survived - -
ied == _
Not
stated | Survived] —}]—| —]| —] 2 J ar fa for | —] —] -] —
ie
Total paralysed
and under In- 3 1 1 4 17 5 5 4 1 1 oo) _ 42
patient treatment

but in four cases the medical notes referred to trophic or gangrenous
bedsores, while in addition one case reported transverse myelitis and
another pyelonephritis. Pyelonephritis was stated as the secondary
cause in 14 cases, pyelitis in 3, pyelonephrosis in 1 and cystitis in 1,
while in 2 cases urinary tract infection was stated; 21 cases therefore, or
37 per cent., had a disorder of the urinary tract as secondary cause of
death. Septicaemia or pyaemia was the terminal cause of 17 deaths,
following in 11 cases upon trophic ulcers or bedsores. Transverse
myelitis was the secondary cause of 2 deaths, and the remainder were
attributable to pulmonary oedema, general cachexia, pyopneumothorax,
perforated ulcer with peritonitis, and severe asthma respectively, each
of these conditions being attributed to paraplegia.

(b) Fracture of trunk bones, other than spine

An estimated total of 4,700 persons was admitted for treatment of
fractures of the trunk bones other than spine during 1940-46, 97 per
cent. being men. In 55 per cent. of the cases one or more ribs were
fractured, and in a further 40 per cent. the pelvis was fractured. The
proportionate admissions for fractures at each site in males is shown in
Table 84, the number of females being too small to warrant inclusion.

TABLE 84
Proportionate Admissions for Fracture of Trunk Bones (not Spine). Males, 1940-46

MRC: Type of Injury | 1940] 1941 | 1942 | 1943 | 1944] 1945 | 1946] 1940-6
ie

8420-1 | Fracture of one or 61 67 | 62 | 49 | 51 48 35 55
more ribs. ‘

8423-4 | Fracture of pelvis . | 33 32 341 39 | 46 | 49 | 59 40

8422; Fracture of sternum

8425-7 | and ill-defined or 6 1 4 12 3 3 6 s
multiple fractures

Totals 100 | 100 | 100 | 100 | 100 | 100 | 100 10¢

THE EMERGENCY MEDICAL SERVICES — 753

For admissions during 1942-46, 298 cards with record of more than
one pathological condition were examined. The principal complications
or accessory acute conditions mentioned were shock, haemothorax,
nerve injuries and respiratory diseases. The frequency with which
they occurred was as follows:

Fracture of
Sternum and ill-
Complication Fracture of Ribs | Fracture of Pelvis | defined fractures
or Accessory of Trunk Bones
Acute Condition
Per- Per- Per-
Number| centage | Number] centage | Number] centage
Shock 12 75 15 12'0 —_ _
Haemothorax 12 75 —_ _ 2 13°3
Injury to sacral, sciatic _ _ 12 0°7 _ _
or peroneal nerve
Pneumonia (all forms) 14 8-8 5 4°0 _ _
Empyema . e : 4 2°5 _— _ _ _
Pleurisy : 14 8-8 1 o'8 _ _
Spontaneous 1 06 = = _ =
pneumothorax
Pulmonary collapse q 4 2°5 1 0:8 1. 6:7
Total cards examined 159 124 15

(c) Fractures of Upper Limb or Limbs

During 1940-46 the sample number of admissions primarily for
fracture of the upper limbs was 6,283 males and 235 females, corres-
ponding to an estimated total of from 31,020 to 31,810 males and 1,100
to 1,250 females actually admitted. The frequencies with which the
various sites were represented in each 1,000 fractures were:

Highest Frequencies Lowest Frequencies

Males Females Males Females
Radius 218 | Radius 407 | Carpal 84 | Radius and ulna 60
Phalanges 149 | Humerus 98 | Ulna 73 | Metacarpals 47
Humerus 146 | Ulna 81 | Radius and ulna 48 | Carpal 34
Metacarpals 129 | Clavicle 72 | Scapula 32 | Scapula jo
Clavicle 119 | Phalanges 72 | Il-defined 9 | Ill-defined 9

Fractures of the radius were commonest in both males and females,
accounting for over one-fifth of all fractures of the upper limbs among
men and for nearly a half of those of women. Fractures of the bones of
the hand were more frequent among males than females, while fractures
of the ulna were commoner among the latter.

Table 85 shows the yearly number of admissions for fractures of an
upper limb in the sample and the estimated total admissions, the
figures for 1944 being shown for two six-monthly periods. The total
number of fractures in 1944 and the first half of 1945 was 35 per cent.

754 CASUALTIES AND MEDICAL STATISTICS

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THE EMERGENCY MEDICAL SERVICES 755

of the total for the whole seven years from 1940-46, while the number in
1944 alone showed an increase of 56 per cent. on the average of the
two preceding years. The period of hostilities in Western Europe was
therefore characterised by a considerable increase in the number of
admissions for fractures. Among men, the increase was particularly
marked in the case of fractures of scapula, humerus, and ulna with or
without radius, for the numbers of admissions for the twelve months
July 1944-June 1945 bore ratios to the corresponding averages for
1942 and 1943 of 2-0, 2-6, 2°5 and 2-6 respectively, and this does not
take into account the large number which would have occurred between
D-day, June 6, 1944 and the end of June of that year.

The proportionate distribution of admissions of Servicemen by age
is shown for certain fractures in Table 86, the fractures chosen being
those for which a large number of admissions were reported and which
might be regarded as among the more disabling. If the period when the

TABLE 86

Fractures of Radius, Humerus and Clavicle. Proportionate Distribution of
Admissions by Age, 1940-43 and 1944-45. (Males)

Year of

Nature of Injury

Admission All
Fracture of Radius 1940-43 1,000
1944-45 1,000
Fracture of Humerus 1940-43 1,000
1944-45 1,000

Fracture of Clavicle 1940-43 1,000

1944-45

greater number of injuries were coming in from the Western Front be
compared with 1940-43, there was a shift in maximum age incidence
from the 15-24 age group to 25-34 for fractures both of the radius and
of the humerus. Fractures of the humerus occurred less frequently at
ages 35-44 during the second period, while fractures of the radius and
of the clavicle were more frequent in that age-group during this period.
The proportion of fractures of the clavicle which occurred at ages
25-34 was greater during 1940-43 than in 1944-45.

The records of admissions during 1944 and 1945 were examined for
mention of certain complications of the primary fracture; these two
years were chosen because they gave a good proportion of the total
admissions during 1940-46 and also because the coders employed on
injury cases had gained considerable experience by the time work on

25CMS

756 CASUALTIES AND MEDICAL STATISTICS

these cases was being done and would be less likely to omit any of the
pathological conditions mentioned. The complications which it was
felt would be most likely to arise were nerve injuries, paralysis due to
nerve injury and loss of muscular or joint function; other possible
complications of trauma such as tetanus or gas gangrene were effectively
prevented by prophylactic inoculations. Surgical amputations were
recorded, however, since the coding rules ordained that the original
injury should be entered as the primary cause of admission and the surgical
amputation recorded in the second diagnosis space on the card in the
same way as with complications. The results, shown as numbers and as
rates per 1,000 fractures of each site, are shown in Table 87.

In the total of 2,510 fractures of an upper limb examined, there
were 7 records of amputations, an over-all rate of 39 per 1,000. The
highest amputation rates were for fractures of phalanges—142 per
1,000, metacarpals—s8 per 1,000, humerus—41 per 1,000, and radius
and ulna—4o per 1,000. According to the site of amputation, 9 per 1,000
were through the upper arms, 3 per 1,000 through the forearm, and
26 per 1,000 were partial amputations of the hand. Injuries to nerves
were recorded for 83 per 1,000 total fractures of an upper limb, the
greatest rates occurring in the case of fractures of the humerus—z209
per 1,000, radius and ulna—174 per 1,000, and the ulna alone—167 per
1,000. The nerves most frequently affected were the radial nerve, in
35 cases per 1,000 fractures, the ulnar nerve, 29 per 1,000, and the
median nerve, 14 per 1,000. Of other possible sequelae, loss of joint
function occurred in 4 per 1,000 of all fractures of the upper limb.

The distribution of periods of in-patient treatment for uncomplicated
fractures of the upper limb is shown in Table 88. For fractures of the
clavicle the median period of treatment for younger men, aged 15-34, was
34 daysand for older men, aged 35-54, 44 days. The corresponding period
for women was 13 days, but this result is based on very few cases. The
median periods for fractures of the scapula were 53 days for younger
men, and 40 days for those older. For fractures of the humerus men in
the younger age group required 12 weeks treatment, compared with 9
weeks for older men and 38 days for women. For fractures of the ulna
men of both age-groups needed in-patient treatment for about 9 weeks,
and the few women who were treated had a median period of 18 days.
The average number of days in hospital for fractures of the radius for
younger men increased from 20 days in 1940-41 up to 54 days in
1944-46, the average over the seven years 1940-46 being 44 days. For
older men the median period was 46 days and for women 18 days.
Fractures of both radius and ulna required 92 and 127 days for the two
age-groups of men and 46 days for women. The greater duration for
males than females was due to the more serious character of their
injuries.

TABLE 87
Fractures of Upper Limb. Frequency of Certain Complications

(numbers and rates per thousand) for Males admitted in 1944 and 1945

THE EMERGENCY MEDICAL SERVICES

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758 CASUALTIES AND MEDICAL STATISTICS

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760 CASUALTIES AND MEDICAL STATISTICS

For males aged 15-34, the percentage of cases of fracture of the
upper limb requiring in-patient treatment for 10 weeks or longer was:

Per cent. Per cent. Per cent.
Clavicle . 18 Scapula . - 67 Humerus. - 56
Ulna . . 44 Radius 7 - 28 Radiusandulna . 57

(d) Fractures of the Lower Limbs

Admissions for fractures of a lower limb formed 49 per cent. of
admissions for all fractures other than those of skull alone among men
patients and 51 per cent. among women. An estimated total of about
48,000 men and 1,660 women were admitted for this cause during
1940-46. The frequencies with which various sites were represented
in each 1,000 lower limb fracture cases for either sex were:

Highest Lowest
Males Females Males Females

Ankle 206 | Ankle 440 | Femur(not 97 | Phalanges 39
Tibia and fibula 192 | Tareal and 145 neck) Patella 27
Tarsal and 133 metatarsal Phalanges 81 | Os calcis 9

metatarsal Fibula 127 | Patella 41 | Femur (not 6
Fibula 112 | Tibia and 117 | Os calcis 29 neck)
Tibia 101% fibula Femoral neck 8 | Femoral neck 0

Tibia go

Fractures of the ankle, which constituted one-fifth of the fractures of
the lower limb among males and over two-fifths among women, were
the commonest among both men and women; fractures of the neck of
the femur were least common among men and did not occur at all
among females.

Table 89 shows the number of yearly admissions for fractures of a
lower limb found in the one-in-five sample and the estimated total
admissions of men and, in the case of fractures of the ankle, of women.
The total admissions for these fractures increased annually during
1940-42, decreased slightly in 1943, increased again during 1944 and
then declined sharply during 1945-46. Men’s admissions during the
latter half of 1944 and the first half of 1945 showed an increase of 44
per cent. on the average for the years 1942 and 1943. The increase was
most marked for fractures of the femoral neck, other parts of the
femur, the tibia with or without a fracture of the fibula and the tarsals
and metatarsals, the ratio of admissions for the twelve months from
July 1944 to June 1945 to the average number for 1942 and 1943
being 4, 2, 1-8, 1-8 and 1°5 respectively. Fractures of the ankle showed
a decreased ratio of 0-8.

761

THE EMERGENCY MEDICAL SERVICES

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762 CASUALTIES AND MEDICAL STATISTICS

TABLE 90

Fractures of Ankle, Tibia and Fibula, and Femur. Proportionate
Distribution of Admissions by Age. 1940-43 and 1944-45 (Males)

Age Groups
Nature of Injury Year of
Admission | 15- | 25- | 35- | 45 up| All

Fracture of Ankle. 5 3 1940-43 | 360 | 446] 171 | 23 1,000
1944-45 | 359 | 441 | 190] 10 | 1,000

Fracture of Tibia. . ‘: 1940-43 | 407 | 433 | 141 19 1 000
and Fibula . ? *: = 1944-45 365 | 491 | 136 8 1,000
Fracture of Femur . . ‘ 1940-43 461 | 419 | 100 20 1,000

1944-45 | 424 | 461 | 110 5 1,000

In Table go the proportionate age-distributions of men admitted
for fractures of the ankle, tibia and fibula and femur (other than femoral
neck) during 1940-43 are compared with similar distributions for
1944 and 1945. For fractures of the ankle there is little difference between
the proportions falling in age-groups 15-24 and 25-34, but the propor-
tion occurring at ages 35-44 was greater during 1944-45. The proportion
of fractures of tibia and fibula at ages 15-24 was greater during 1940-43,
whereas the proportion at ages 25-34 was 491 in the second period
compared with 433 in the first. This shift in maximum incidence
from the younger to the older age group which was also apparent for
fractures of the femur, had previously been noticed for fractures of the
humerus and radius. When all admissions for diseases are considered,
the proportionate age distribution is as follows:

Year of Age Groups
Admission
15- 25- 35- 45 up All
1940-1943 398 414 160 28 1,000
1944-1945 352 429 197 22 1,000

A corresponding shift is noticeable here and one explanation of this
may be a changed age distribution of those at risk, due to a more
complete call-up of men aged 30-35.

As in the case of fractures of the upper limbs, the records of admis-
sions during 1944 and 1945 for fractures of the lower limbs were
examined for complications of the primary fracture, surgical ampu-
tations, as explained above, being treated as complications of the
primary injury. The results are shown in Table 91.

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THE EMERGENCY MEDICAL SERVICES

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764 CASUALTIES AND MEDICAL STATISTICS

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765

THE EMERGENCY MEDICAL SERVICES

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766 CASUALTIES AND MEDICAL STATISTICS

In examining the case histories of 3,879 patients admitted for fracture
of a lower limb, records of 139 amputations were found, an over-all
rate of 36 per 1,000. The highest amputation rate was 68 per 1,000 in
cases of fracture of femur other than femoral neck; the rates for fractures
of tibia and fibula and of phalanges were each 58 per 1,000. According
to the site of amputation for fractures of lower limbs in this series,
g per 1,000 had an amputation above the knee. Injuries to nerves were
recorded in 1 out of every 50 cases; in 1 out of 10 cases of fracture
of the femoral neck and in about 1 in 15 cases of fractures of femur
other than neck. The sciatic nerve was injured in 83 cases per 1,000
fractures of the femoral neck and 58 per 1,000 cases of other fractures
of the femur. Fractures of these two sites also had the highest over-all
rates of incidence for the types of complication under discussion.

Table g2 shows the distribution of periods of in-patient treatment
for fractures of the lower limbs, and the median period in hospital for
cases in which no pathological condition but the fracture was recorded.
The median period of treatment for males aged 15-54 with fractures
of the femoral neck was 21 weeks, and for other fractures of the femur
a little under 6 months. Fractures of the patella required 103 days on
an average for men aged 15-34 and 60 days for older men. Fractures of
the tibia necessitated hospital treatment for over 3 months for men in
each age group and about 10 weeks for women. The median period for
fractures of both tibia and fibula was around six months for men but
only 77 days for women, while fractures of os calcis also required an
average of 3 months in-patient treatment.

For males aged 15-34, the percentage of cases of certain fractures of
lower limbs requiring in-patient treatment for six months or more was
as follows:

Per cent. Per cent.
Femur (other than neck) 44 Fibula 8
Patella 19 Tibia and fibula 42
Tibia 18 Os calcis 13
Ankle, including Pott’s and Dupuytren’s fractures 6

(e) Multiple Fractures

The M.R.C. Classification provides combination code numbers for
fractures of multiple sites. (Numbers 8450-8459.) Admissions for
multiple fractures in the sample numbered 2,023 males and 29 females;
the estimated total number of men admitted for this cause lies around
10,000, The sample number of admissions and the estimated total
numbers for various combinations of sites are shown in Table 93.

The principal causes of admission in this group were fractures involving
either both lower or both upper limbs or upper and lower limbs.

767

THE EMERGENCY MEDICAL SERVICES

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768 CASUALTIES AND MEDICAL STATISTICS

While such fractures may not be among those most dangerous to life
they present an important problem from the point of view of possible
loss of working power, so that in addition to ordinary hospital treat-
ment it is necessary to provide rehabilitation centres and training
courses for instruction in new methods of earning a living. This
question applies in greater or less degree to all fractures and led to the
undertaking of a follow-up of certain fracture cases, the results of which
will be presented in the next section.

The proportionate distribution of admissions for multiple fractures
over the seven years is as follows, males only being considered:

1940 1941 += :1942, 1943, 1944 «1945-1946 = Total
82 97 133 145 3390 161 43 1,000

Half the admissions for multiple fractures therefore occurred in 1944-45.

The number of admissions for multiple fractures during the 12
months July 1944-June 1945 bore the following proportions to the
average admissions during 1942 and 1943 for fractures of the same
combination of sites.

Skull and trunk bones 0-9 Upper limb and lower limb 2-4
Skull and limb or limbs 1°5 Upper limb and trunk

Spine and other trunk bones 2-5 (not spine) 2-2

Spine and limb or limbs 1'9 One or both lower limbs,

One or both upper limbs, except tibia or fibula 2-9
except radius and ulna 2-4 Lower limb and trunk

(not spine) 49

Other or ill-defined 11

Except for fractures of the skull and trunk bones there was an increase
in the number of admissions during the period of fighting on the
Western Front over the average for the two years prior to 1944. This
excess was particularly marked in cases in which the lower limbs were
involved.

Table 94 shows the amputation rates for Servicemen admitted with
multiple fractures involving either upper or lower limbs or both.
Of 515 cases admitted for multiple fractures of one or both lower
limbs, 18 had both legs or feet amputated and a further 83 lost one leg
or foot; thus roughly one in five of these cases required an amputation.

(f) Follow-up of Cases of Fracture of either an Upper or a Lower Limb

In the hope of obtaining some information about the period of
disability due to fractures of either an arm or a leg, 1,000 cases of such
fractures admitted to E.M.S. hospitals during 1944 and 1945 were
followed up by letters of enquiry sent out during the latter half of

789

THE EMERGENCY MEDICAL SERVICES

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770 CASUALTIES AND MEDICAL STATISTICS

1946 and the beginning of 1947. The letter of enquiry informed the
patient that for research purposes information was being collected
about the number of weeks of incapacity following certain kinds of
fractures and he was assured that the information was to be used for
statistical purposes only. The questions asked were:

(1) Name of Hospital from which you received your discharge.

(2) Date of leaving that hospital.

(3) Occupation before entering the Service.

(4) Date of resuming that or a similar occupation or
Date of commencing a lighter occupation.

(5) Date when certified as fit to resume your former occupation or
Date when certified as fit for a lighter occupation.

The first two questions helped in correctly identifying the subject of a
record card with the appropriate questionnaire in cases where there
were two or more people with the same name and injury. In the
interests of accuracy the remaining questions were made as simple as
possible.

In all 566 usable replies were received. When the patients’ files were
being searched for their most recent address, it was noticed that a
great many had had several changes of residence, and it is therefore
probable that in addition to those forms which were returned to the
central office marked ‘Unknown’, there were others which failed to
reach the subject of the enquiry because he had moved away. It may be
that this mobility was in some measure due to the housing shortage
obliging people to live in rooms, thus making them less stable than if
they were living in houses. In any case the problem of tracing those
who move from one address to another is a serious one for anyone
attempting a follow-up by postal enquiry. A second reason for failure
to answer the questions may have been a fear that the answers could
be used in some way as a means of reducing the assessment of disability
pension. Whether those who were still seriously handicapped or those
who had recovered full use of their limb would be more likely to reply
is a matter for speculation.

In Table 95 the numbers who were certified as fit for work and those
who resumed work are shown according to the type of work undertaken
or for which they were judged suitable. Under the heading ‘None’ on
the left-hand side of the table are included those who had not resumed
work, some who were still in hospital or under treatment and those
who did not reply to question 4 above, while on the right-hand side
under ‘None’ are entered those who had not been certified as fit for
work and those who did not answer question 5. Where a patient first
started a lighter occupation and later resumed his old one, the former

THE EMERGENCY MEDICAL SERVICES 771

TABLE 95

Follow-up of Fracture Cases. Numbers who resumed previous or lighter
occupations and numbers certified as fit for resuming work

Type of Work for

Site of Fracture which Certified Fit

Humerus. & rs 7 Ir 16
Ulna a A . ar 15 2 4
Radius (including

Colles’s, Smith’s) . 7 6 I _
Radius and ulna . : 17 9 3 4
Carpal bones . . 4 3 _- a
Metacarpal bones ; 6 5 1 _
Phalanges . . 2 2 1 1 _
Total, Arm and Hand 128 19 24

Percentage é 100 67 15 19
Femoral neck 5 5 4 2 _ 1
Femur, other than neck 193 110 44 39
Patella 3 . 2 8 5 3 I
Tibia e f S 64 16 17
Fibula e . . 14 3 4
Tibia and Fibula e 153 35 47
Tarsals and Metatarsals 2 1 I
Total, Leg and Foot . 438 110

Percentage . O 100 56 25

has been counted for the purpose of this survey. Furthermore, in analys-
ing these cases according to the site of the fracture which was the
principal cause of admission to hospital, it has not been found possible
to take into account other concurrent diseases or injuries such as for
example open wounds, burns or dislocations.

Sixty-seven per cent. of those with fractures of an upper limb took
up a lighter occupation than they had had before their service with the
Forces, compared with 56 per cent. with fractures of a lower limb.
The difference between these proportions is significant. (Difference 11;
2.SE = 9°5.) Sixty-six per cent. with fractures of an arm or hand and
52 per cent. with fractures of a leg or foot were certified as fit for a
lighter occupation, the difference between these results also being sig-
nificant. (Difference 14; 2.SE = 9-6.) There were 8 people with frac-
tures of the arm or hand and 20 with fractures of leg or foot who were
either still in hospital or attending for out-patient treatment so often
that it was impossible for them to work. A number of those who had
been certified fit for a light occupation but had not yet started working
were awaiting admission to a training centre. Twenty-two per cent,
with fractures of an upper limb and thirty-three per cent. with fractures
of a lower limb were able to resume their pre-war occupation.

772, CASUALTIES AND MEDICAL STATISTICS

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THE EMERGENCY MEDICAL SERVICES = 773

In Table 96 are shown the periods from date of injury to date when
certified fit for work, and the median periods of incapacity. For 55
cases of fracture of the humerus the median period was about 48 weeks
and 23 per cent. of the cases were incapacitated for 18 months or more.
Taking all fractures of an upper limb together, the median time of
unfitness for work was 357 days. Fractures of the femur other than the
femoral neck showed a median period of 438 days or rather less than
15 months, based on 150 cases, and fractures of tibia and fibula a
median period of 405 days or about 59 weeks, based on 106 cases.
For fractures of the tibia alone the median time of incapacity based on
45 cases was also just under 15 months. If all the 322 fractures of leg
or foot be considered the median period was 421 days or about 60 weeks.
Since the majority of fractures (75 per cent. and 73 per cent. for upper
and lower limb respectively) were due to operations of war, of which
the chief would involve bombs, mortars, gunshot and various kinds of
high explosives, it is possible that the fractures under consideration
would involve greater bone damage than many of the fractures to which
a civilian population would be subject in peace-time, and hence that
the periods of incapacity shown here are greater than would normally
be expected.

The distribution of periods from date of injury to date of starting
work is shown in Table 97. For fractures of an upper limb the median
periods were longer than the corresponding ones in the preceding table,
except for fractures of the carpal bones, the number of which is very
small in any case. The median time before starting work for those
with fractures of arm or hand was 6-7 weeks longer than the median
time before being certified as fit for work. For fractures of a lower limb
the median time from injury to starting work exceeded the time until
certification of fitness for work when the femoral neck, the fibula or
both tibia and fibula were involved, but was less for fractures of other
parts of the femur, the patella or the tibia. Taking all fractures of the
lower limb, there was little difference between the two intervals.
Many of those who had had fractures subsequently spent as much as
six months in a Government Training Centre learning a new occupa-
tion, and in some of these cases there was time spent in awaiting admis-
sion to the Centres, facts which will partially explain the differences
between the periods shown in Tables 96 and 97.

Table 98 shows that 446 patients out of 1,000 with fractures of either
an upper or a lower limb started work not more than one week after
being certified as fit to resume their occupation; 38 per cent. of those
with fractures of an upper and 47 per cent. of those with fractures of a
lower limb are included in this total. Eight per cent. of those with
fractures of arm or hand and 7 per cent. of those with fractures of leg
or foot started work before being certified as fit; in this connexion the

774 CASUALTIES AND MEDICAL STATISTICS

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775

THE EMERGENCY MEDICAL SERVICES

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778 CASUALTIES AND MEDICAL STATISTICS

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THE EMERGENCY MEDICAL SERVICES 777

possibility that the answers to questions 4 and 5 of the enquiry sheet
were interchanged must be taken into account. Four weeks after the
date of being certified fit for work, only 292 per 1,000 were not employed;
six months after certification only 43 per 1,000 were still not at work.

For the sites of the three largest numbers of fractures in this series, a
comparison is made in Table 99 of the proportionate distribution of
periods of in-patient treatment and incapacity for work and of non-
working periods. The median period of treatment in hospital for frac-
tures of the humerus was 7} months, of the femur other than the femoral
neck ro months and of tibia and fibula 9} months. The periods of
incapacity in these three cases were approximately 1}, 14 and 1-4
times as long as the periods in hospital, while the median periods from
injury to resumption of occupation were 1-9, 1-4 and 1-5 times as long
as the median periods of in-patient treatment.

As the number of returns (566) was less than had been hoped for, it
was not considered advisable to attempt any analysis by occupation,
especially as from the point of view of fitness for work, a very detailed
break-down would be required.

ACUTE POISONING (Short List Number 40)

This Short List Number comprises acute poisoning by toxins and
substances other than gases, poisoning and other injury by gases and
late effects of acute poisoning. The number of admissions in the sample
during the eight years 1940-47 for these conditions was 357 males and
60 females, giving an estimated total number of from 1,980 to 2,185
persons admitted. The ratio of admissions for this cause to 1,000
admissions for non-infective and non-respiratory diseases in the eight

years was:

1940 1941

Males. . 1 2
Females. 2

The rates for males did not rise above 3 per 1,000 in any year and those
for females only rose above 4 per 1,000 in 1946 and 1947 when the total
number of women admitted was small.

The principal causes of admission in this group for the whole period,
with sample numbers of patients and estimated totals were as
follows:

778 CASUALTIES AND MEDICAL STATISTICS

Food Poisoning:
by bacterial toxins
botulism; other agents

Totals .

Acute Poisoning:

by narcotic, analgesic or soporific drugs
by corrosive substances
by other substances (not gases)

Totals .

820 + 64

Poisoning and Other Injury by G Gases:
monoxide .
war gases; screen smokes
vesicants
others .

other gases.
Totals .

Late Effects of Acute Poisoning .

BURNS (Short List Number 41)

The M.R.C. code provides a dual classification for burns, the third
digit indicating the agent causing the burn and the fourth digit the part
of the body involved. During 1940-47 the sample number of males
admitted with a primary diagnosis of burns was 2,555, and of females
252; it is estimated therefore that about 12,800 men and 1,340 women
were admitted for this cause. Sunburn (M.R.C. Code 936) is excluded
from these figures.

TABLE 100

Burns. Ratio per 1,000 Admissions for Non-infective and Non-respiratory
Illnesses, by Sex and Age. 1940-47 (Service Cases)

Age Groups
25- 35- | 45-54

THE EMERGENCY MEDICAL SERVICES 779

Table 100 shows that among Servicemen the ratio of admissions for
burns to the basic total of admissions varied between 1 per cent. and
3°4 per cent., the maximum ratio occurring in 1944, whereas for
women the ratio varied from 0-4 to 1-4 per cent. Among males the
rates for burns tended to decrease with age except for 1947. The
highest ratios, 43 and 36 per 1,000 were for men aged 15-24 and 25-34
in 1944.

An analysis of the total admissions for burns by the part of the body
affected is shown in Table 101. About one quarter of men’s admissions
for burns were included in group 6, the face, head, neck and limbs

TABLE 101

Burns. Total Admissions for 1940-47, by Part of Body affected

Females

M.R.C. Site of Involvement
Suffix Numbers | Proportion} Numbers | Proportion
° Face, head and neck. 115
1 Trunk : 3 a 20
2 Upper limb or limbs. 107
3 Hand or hands. @ 83
4 Lower limb or limbs. 461
5 Face, head and neck,
trunk and limbs 2 16
6 Face, head and neck,
limbs 5 Q e 79
7 Trunk and limbs ‘i 44
8 Other and unqualified
areas . 75
0-8 Totals . ‘ 1,000

being involved, while in a further 19 per cent. the lower limbs only
were affected. Forty-six per cent. of women’s admissions were for
burns of the lower limbs only, and 12 per cent. involved injury to the
sites in group o. In 1944, the year in which the number of men admitted
for burns was greatest, 29 per cent. had involvement of the sites in
group 6, 13 per cent. of those in group 4 and 17 per cent. of one or
both hands.

An analysis of burns by their causative agent is shown in Table 102.
Nearly half the burns among men were caused by fire or hot objects and
roughly another 20 per cent. by hot liquids or vapours; 64 per cent. of
women’s burns were due to scalding and 14 per cent. to fire or hot
objects. The case records of 400 patients admitted for burns during
1942 and 1943 were examined in detail, and it was found that of 170
burns caused by fire and hot objects, 43 per cent. were due to burning
Petrol, 25 per cent. to flames from fires, blow-lamps, cookers, etc.,
13 per cent. to incendiary bombsand other instruments of war. (Brooke,

780 CASUALTIES AND MEDICAL STATISTICS

TABLE 102
Burns. Sample Total Admissions for 1940-47, by Causative Agent

Females

M.R.C. Causative Agent |______—_

Code Numbers | Proportion} Numbers | Proportion
930 Fire or hot objects 139
931 Hot liquids or vapours . 638
932 Corrosive liquids 36
933 Various forms of

radiations 4
934 Electric currents 12
935 Other agents, or

unqualified 171
930-5 Totals 1,000

1945.) There seems little doubt that many of the admissions for this
cause were due to avoidable accidents.

In the sample of 400 cases, it was found that the distribution of
burns according to degree was as follows:

Ist degree 2nd degree 3rd degree Not stated All Types
Males 9°6 42°8 68 40°8 100
Females 22:2 37°8 ° 40-0 100

For men the median number of days treatment, including any
period of treatment at the unit before admission to hospital, for burns
to face, head, neck and limbs was 18 days for first degree burns, 20 days
for second degree, 30 for third degree and 19 for all burns of this site
including those whose degree was not stated. Women with burns of
the lower limbs required 15 days treatment for those of the first degree,
35 days for those of the second degree and 26 days for all burns of
this site.

OTHER INJURIES (Short List Number 42)

This group includes open wounds (except of scalp), bruising and
contusions with intact skin surface, foreign bodies where admission was
primarily for their removal, crushing injuries and traumatic amputations.
It also contains a number of conditions which are sequelae of trauma,
general effects of external causes, therapeutic misadventures and late
complications of therapeutic procedures. In such conditions there is
a very wide range in degree of severity so that tables of duration of
treatment in hospital would tend to reflect the gravity of the injury
rather than give a picture of the amount of hospital time required for
restoring the patient to health. For this reason, no attempt is made here

781

THE EMERGENCY MEDICAL SERVICES

c 338i

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Ofr'r

6gh‘r * S[BI0,7,

6Sz ze

peyrenbun so afdiainyy

. i % uawopge jo
Aanfur jeusajut ym spunom uedQ

: iy : 3sayo jo
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(Jetoysadns) yunsy,
* "yan, pue aoeg

Puno, uado jo ane

Lbe-oF 61 ‘unuanassg fo suorsstuppy ‘spunoyy uadQ
for rlavy,

782 CASUALTIES AND MEDICAL STATISTICS

s[OL,

Lo * . i + sureids pauyap-|]! pus 12410,
gz . ? $ ual oeifI-ol9es Jo auldg
Loz F . . 5 : : . apy
Ler : . % : y y : + aay
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ureng Jo ursidg jo aig

Lt-ob61 ‘uawaniasag fo suorssuuppy ‘suiwsig puv suivadg:

vor qIavy,

THE EMERGENCY MEDICAL SERVICES — 783

to show anything beyond the numbers of men admitted to hospital
each year for those of the injuries in this Short List Group which
occurred most frequently.

In the one-in-five sample there were 13,323 men and 321 women
admitted with a principal diagnosis of open wounds; hence the estimated
total number of Servicemen admitted to E.M.S. hospitals for this
cause was about 66,600. Table 103 shows that wounds of one upper
limb, one lower limb, and of multiple sites each comprised just under
a quarter of the total number. Admissions for this cause in the second
half of 1944 and in 1945 formed 36 per cent. of the total admissions in
the eight years.

The most frequent cause of admission after open wounds was
sprains or strains, and from Table 104 it may be seen that the commonest
sites were knees and ankles. The greatest number of sprains or strains
occurred in 1942 which might be regarded as pre-eminently a training
year with the Armed Forces. Taking the three age groups 15-24,
25-34, 35 and over, the percentage of sprains in each group was:

Knee, 41, 45,14; | Ankle, 43, 44,13; | Other sites, 42, 40, 18

The proportion of sprains occurring at ages 25-34 was therefore higher
for injuries to ankle or knee than for other sites. If to the 1,608 men
with sprained knees be added the 3,890 whose primary cause of admis-
sion was internal derangement of the knee joint, a sample total of
5,498 admissions is obtained, to which corresponds an estimated total
of 27,500.

Another large group of admissions was attributable to bruising,
contusion or haematoma, with intact skin surface. For this cause
3,802 men and 229 women in the sample were admitted to hospital, the
number of yearly admissions being shown in Table 105. Bruising of the
trunk and of a lower limb or hip together accounted for half the total
admissions for this cause, and the highest yearly number of cases occur-
red, as in the case of sprains or strains, in 1942.

The numbers treated primarily for dislocations (Table 106) also
showed a maximum in 1942. The site most commonly affected was the
shoulder, this being the part affected in nearly two-fifths of all disloca-
tions.

For the group of conditions shown in number 94 of the M.R.C.
Classification, under the title of ‘General Effects of External Causes’,
1,593 men in the sample were admitted; an analysis of these admissions
is shown in Table 107. More than half these patients were admitted
with a diagnosis assignable to M.R.C. number 9496, and of the 818
men admitted for this reason in 1944, the majority were suffering from
Battle Exhaustion, a syndrome brought on by the stress of conditions

784 CASUALTIES AND MEDICAL STATISTICS

sasorypEWasYy puB BuIsINiq 19430
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Sor wiav,L,

BWOJBWaBL] JO UOISMaUOD ‘BuIsmIg

DUojDULaD ET 40 UOISNIUOD ‘Sursinsg

785

THE EMERGENCY MEDICAL SERVICES

000‘T

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786 CASUALTIES AND MEDICAL STATISTICS

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*IBM-JO-B19UOSd BurUINyas UT UONLANUyEW sapNpouT apn SNL, ,

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Lb-ob61 ‘unuanass fo suossnuppy ‘sasnvD jousaixg fo sizaffq josquas)
Lor qiavy,

THE EMERGENCY MEDICAL SERVICES 787

of warfare on the Western Front. A detailed analysis of the records of
500 such cases, who were not at the same time suffering from either
trauma or disease has already been presented (Brooke, 1945). The
age distribution of these patients showed no marked difference from
that of all injury cases. The median period in hospital for men aged
15-34 was 54 days, which is 9 days longer than for a random group of
patients with non-combat neurosis. It was further noticed that men with
less than 2 or more than 4 years’ service were the more likely to break
down. As regards family influence, it was found that nearly three-
quarters of those whose family history had been recorded had one or
more unstable first degree relatives while many of the patients who
broke down had shown such predisposing traits as ‘nervy or neurotic,
fears, somatic symptoms, shy, solitary or moody’. Cases did not appear
to occur more frequently in active than in passive units and the general
conclusion was that an inherited predisposition to instability rather than
an external factor was the causative agent of the breakdown.

In 1945 a number of returned prisoners-of-war in a serious state of
undernourishment were admitted to E.M.S. hospitals. The diagnosis
in these cases was coded to M.R.C. 942, since it was felt that these men
were suffering from deprivation of food rather than malnutrition in
the sense in which it is implied in M.R.C. number 269. In all 266 men
in the sample were admitted for this condition, or about 1,330 actual
admissions.

The remaining group of importance in Short List Number 42, is
that of complications of trauma where these were primary causes of
admission. From Table 108 it will be seen that nearly half the admissions
in this group were due to loss of joint function following recent injury,
the estimated total admitted for this cause being between 2,845 and
3,085.

HOMOLOGOUS SERUM JAUNDICE (See p. 690)

Though not generally appearing as a primary cause of admission,
a condition which caused great concern was jaundice or hepatitis
following the administration of blood, plasma or serum. (M.R.C.
Code 963.) The appearance of hepatitis in patients who received
inoculation with blood products was not an occurrence peculiar to the
Second World War, but the increase in the number of casualties so
treated, with a resulting increase in the number developing homologous
serum jaundice served to focus attention on the problem. Oliphant
(1944) gives a chronological list in which the earliest report was that of
Hirsch (1883-84), recording the vaccination of 1,289 persons with
humanised lymph in glycerine, as a result of which 191 people developed
jaundice, the incubation period varying from several weeks to 2 months.
Further cases were reported following the administration of convalescent

26CMS

788 CASUALTIES AND MEDICAL STATISTICS

* Bune Jo Suoneordusos 22NO
Aanfur quaoas
“aur joy uorsoun: 3urof jo 8
: OT105 y Eee oe
opeUIeD Jo BrEDs Woy swojydurig
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03 anp uonsuTy sJelnosNUT jo S607]
Amfur aasou 03 anp sisfjexed quaysieiag
Aanfur 3urmoyjoy snuts yuaystesag
spunom jo Bureay padvaq,

sume], Jo
uoresldwios jo anjeNy

Lb-ob61 ‘uawanasag fo suousuipy ‘vunvsy, fo suoynryduoD
gor w1avy,

THE EMERGENCY MEDICAL SERVICES 789

measles serum (MacNalty, 1937), Yellow Fever vaccine (Findlay and
MacCullum, 1938; Soper and Smith, 1938; Fox and others, 1942),
blood transfusion, mumps convalescent serum (Ministry of Health,
1943), citrated blood and pooled plasma (Beeson, 1943) and serum,
plasma or both (Morgan and Williamson, 1942). If when pooled blood
products are used, one donor has contributed an icterogenic agent, any
or all of the recipients of this blood are liable to infection. Further,
Bradley, Loutit and Maunsell (1944) have shown that in their series of
cases the clinical features and biochemical findings in homologous
serum jaundice were indistinguishable from those of infective hepatitis,
so that diagnosis must depend on a history of injection or transfusion.
It is not possible to detect by laboratory or animal tests the presence of
an icterogenic agent in blood intended for transfusion, which makes
accurate recording of batch or bottle numbers desirable. The distinguish-
ing feature of homologous serum jaundice is its long incubation period
of 2-3 months as compared with 20-40 days in the case of infective
hepatitis.

In an attempt to estimate the incidence of serum jaundice all case
histories in the sample of E.M.S. hospital admissions which had already
been coded to jaundice were re-examined for mention of blood trans-
fusion or inoculation. At the same time all incoming records were
examined and information was recorded about the three following
groups:

(i) injured patients who were transfused.
(ii) sick patients who were transfused.
(iii) injured patients who were not transfused.

The size this investigation would assume was not anticipated at the
start, or the records of blood transfusion jaundice got from re-examining
jaundice cases would have been kept separate from those obtained from
incoming records. The following tables, while not covering all cases
in the three groups admitted during 1940-45, give some indication of
the incidence and case-fatality rates among Servicemen under observa-
tion for 3 months or more after injury or transfusion.

TABLE 109

Incidence of Jaundice following Blood Transfusion, 1940-45, among
Servicemen under observation for 3 months or more after transfusion or injury

Numbers who

Group whose Total number of Number of these | Incidence rate per

hospital records patients whose _ developed who died 1,000 in observation
‘were examined records were jaundice during subsequently period (and
examined observation to jaundice standard error)
Injured patients who
. Were transfused 1,316 17 94+8
Sick patients who
Were transfused 2 82 16 7 195449
Injured patients who
Were not transfused. 6,350 6 ° o-gt0'3

7909 CASUALTIES AND MEDICAL STATISTICS

Table 109 shows that in all 7,748 records were examined in the three
groups and that of 1,398 sick or injured patients who were transfused,
140 subsequently developed jaundice of whom 24 died. The overall
incidence and case-fatality rates in the transfused group were 100 and
171 per 1,000 respectively. Among injured patients who were not trans-
fused there were 6 cases of jaundice of whom none died, the incidence
rate being therefore 0-9 per 1,000. The incidence rate among injured
patients who were transfused was 94 per 1,000 and the case-fatality
rate 137 per 1,000. The case-fatality rates when compared with that of
2°4 per 1,000 for cases of infective hepatitis show a much higher death-
rate among cases of homologous serum jaundice.

Jaundice was known to be rife among both Allied and enemy forces
in North Africa, hence it might be that where a record of blood trans-
fusion and of a subsequent attack of jaundice occurred in a case from
the Mediterranean theatre of war, it was by a coincidence that they
occurred to the same patient. The 7,666 cases of injury were therefore
analysed according to the theatre of war in which the injury was received,
and the results are shown in Table 110.

TABLE 110

Incidence of Jaundice following Blood Transfusion. Admissions for
injuries analysed by Theatre of War in which injury occurred

Transfused Not Transfused
Total jaundice | Died after} Total | Jaundice | Died after
examined | developed | jaundice | examined | developed | jaundice
Mediterranean z - 308 55 6 905 ° °
‘Western Europe. A a 613 55 9 2,133 ° °
Far East. . . . 30 A 1 80 ° °
United Kingdom s n 10° 1 1,240 3 °
Not stated. . . : 2s I ° 1,992 3 °
Totals 2 es ; 1,316 124 17 6,350 6 °

Jaundice therefore occurred in 179 per 1,000 of those who were injured
in the Mediterranean theatre and subsequently received a blood trans-
fusion, whereas there was no instance of jaundice reported among 905
men injured in that theatre but not transfused. In Western Europe
go per 1,000 of those injured and transfused developed jaundice, but
no mention of jaundice occurred in the records of 2,133 men who
were injured but not transfused. The incidence of jaundice was greater,
for every theatre of war, among the transfused than among those who
had not received transfusion.

In considering the incidence of jaundice in the cases discussed above,
no attention has been paid to the period between transfusion and onset
of jaundice. In some instances the administration of blood of an incom-
patible group produced a reaction within up to 14 days; allowing there-
fore for delay in recording, it might be assumed that where jaundice

THE EMERGENCY MEDICAL SERVICES = 791

was stated to have appeared in less than 10 days from the transfusion,
it was haemolytic, rather than homologous serum jaundice which was
observed. In cases which appeared to have a short incubation period,
the possibility that the patient was experiencing an attack of an infective
hepatitis contracted before the transfusion was given cannot be ruled out.

The search for cases in which jaundice followed blood transfusion
was continued after the above tables had been made, and altogether
175 cases were found. The intervals between transfusion and the
appearance of jaundice showed the following distribution, two or
more periods being recorded where more than one transfusion was
given. (The left-hand number of each pair shows the number of days
elapsing; the second number gives the frequency.)

Days F.|Days F. F.|Days F.|Days F.|Days F. F. F.
rf4] i]t 2 3 6 3 1
a3]2] 23]1 2 5 3 1 1
4)r 27) 1 1 5 5 3 of
H - 28/3 3 2 4 2 I

1] 30]}2 1 2 4 1 1
8]2] 3r]1 1 3 2 3 :
ott 32 )3 2 3 3 4 T
urfr] 33] 1 4 5 3 1
wz]2] 35) 4 3 4 3 3 1
wir] s8]2 4 3 1 3 1
w}2] 42) 1 2 4 3 1
T t 1 3 7 3 3
Wr % 1 3 2 2 3

2 less than 12, 1 not more than 76,
1 not more than 77; one more than 92.

Of the cases in which the periods were stated exactly, 13 had intervals

of less than 10 days and there were 276 with intervals of 10 days or more.
If those cases with less than 10 days’ interval be regarded as haemolytic
jaundice, the median interval for the remaining cases is 85 days, the
lower quartile being 65 days and the upper quartile 107 days.
In 152 cases there was a record of either blood or plasma or both having
been given; the total quantities administered to each patient were
estimated and the distribution is shown in Table 111. In all 54 people
received blood only and 27 received plasma only, while the remainder
received varying quantities of each. In addition 4 people received
serum only, 2 serum and blood and 1 had serum, blood and plasma.

In records of infective hepatitis the most frequently mentioned first
symptoms were:

nausea 18 per cent. anorexia 18 per cent.
abdominal pain 16 per cent. vomiting 11 per cent.

The same symptoms were among the first five most frequently
mentioned in cases of homologous serum jaundice, with frequencies:
nausea 14 per cent. anorexia 16 per cent.
abdominal pain 17 per cent. vomiting 18 per cent.

792 CASUALTIES AND MEDICAL STATISTICS

TABLE 111

Jaundice following Blood Transfusion. Distribution of Total Quantities
of blood and plasma given to each patient

Plasma (pints)

° All

o}]— 27

1 12 28

2 | 12 24

3 6 24

Blood 4 4 6
(pints)| 5 | — 4
6 5 8

7 2 3

8 2 4

9 |— 2

1o | — 2

1 1 3

12 I 3

N.S. 9 14

All | 54 152

In the latter, however, bile-stained urine was the first symptom men-
tioned in 18 per cent. of the cases, compared with 6 per cent. in cases
of infective hepatitis.

While the investigation was being carried out the question was raised
of whether the administration of pentothal was in any way connected
with the incidence of jaundice. The records of those who had had
homologous serum jaundice were therefore re-examined for mention
of pentothal, and this was found in 63 cases or 36 per cent. The intervals
between administration of pentothal and onset of jaundice were
distributed:

Days F.|Days F.|Days F.|Days F.|Days F.|Days F.|Days F.|Days F.|Days F.
4] qolr 57 | 2 69 | 1 79 |1 92} 1] 109 | 2] 122] 1] 161] 4
to} rt “it 9} 2 qo}4 814 o4) 2] ro] 4] 123] 1] 218]
W]1 49/1 ol Tr 932% 82]2 os |2]arm |] 1] 130] 1 | 280] 1
26/1] so}r 63) 2] 74/2] 83] 1 | 100] 1] 114] rt] 132] 1 | 327] 2
go}r ree 64/1 75 |2 8. rjaor]4r] or 1} 35]
3rid s2|1 65 |2 76\1 8 4] 104) 3 | 11 1] 136]

34,1 53] 1 67 | 1 7) 89 | 2 | ro tr) 19 ]2] 142] 4
39] t] ss} x] 68) 3] 78)4] 90/4] 107] 3] 121] 1] 159] 0

The median interval was 82 days, the lower quartile 57 days and the
upper quartile 106 days. The distribution was very similar to that for
intervals between blood transfusion and jaundice. Such a similarity
would however be expected since it was usually shortly after injury
that the patient was anaesthetised while his injuries were being dressed
and then also that he received blood transfusions. It was not possible

THE EMERGENCY MEDICAL SERVICES 793

at the time to select a series of cases from which all other possible jaun-
dice-causing factors were absent and in which some had and others had
not had pentothal.

There were 23 deaths in the series, but the cause of death was not
stated in every case. Among the eighteen in which the cause was
defined, 3 were attributed to acute yellow atrophy following infective
hepatitis, 3 to necrosis of the liver, 3 to toxic hepatitis, 2 to liver failure
due to infective hepatitis and 1 to jaundice and cerebral abscess.

EXTERNAL CAUSES OF ACCIDENTS

The external causes of accidents are classified in the M.R.C. List in
three main groups, traffic accidents, those chiefly likely to occur in the
course of an occupation, whether civilian or with the Services, and other
accidents such as falls, blows, injuries at sport, etc. (Detailed list p. 740.)
Accidents treated in E.M.S. hospitals are further classified according
to whether they were stated in the records to be due to enemy action or
not so stated; the number ascribed to operations of war may therefore
be an understatement of the true figure. The proportions of total
admissions assigned to M.R.C. numbers 80-96 which were ascribed to
enemy action in the seven years 1940-46 were as follows:

1949 1941 1942 1943 1944 1945 1946 1940-46
Percentage 27 5 3 9 48 25 2 23

In the sample only 494 traffic accidents were assigned to enemy
action, of which 233 occurred in water transport and 1509 in air transport.
It is estimated that about 65,000 Servicemen were admitted for traffic
accidents not due to operations of war. The annual proportionate
composition of admissions for these reasons, together with the estimated
total admissions for the whole seven years are shown in Table 112.

The largest group involved in traffic accidents were drivers of motor-
cycles injured on the road, about 23,000 being admitted to E.M.S.
hospitals. Admissions of motor cycle drivers varied between 29 per cent.
and 38 per cent. of all traffic accidents in the seven years and formed
35 percent. of all traffic accidents other than those due to war operations
during 1940-46. Passengers or unspecified occupants of motor vehicles
formed the second largest group, about 11,500 being estimated to have
been admitted, with annual proportionate rates varying between
15 per cent. and 21 per cent. of the total in each year. Admissions for
water transport accidents were estimated to be about 2,200 but these
would in all probability be due to accidents occurring round our shores;
further, a good proportion of men would go to one or other of the Royal
Naval Hospitals, while those incurring accidents during long voyages

794 CASUALTIES AND MEDICAL STATISTICS

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zi wav,

THE EMERGENCY MEDICAL SERVICES — 795

would have been treated on board and in all probability not need
hospital treatment on reaching their destination.

TABLE 113

Proportionate Composition by Nature of Injury of Admissions due to certain types
of Traffic Accidents (including those due to Operations of War) among Male Service
Personnel, 1940-46

M.R.C. M.R.C. Suffix for External Cause of Accident
Code Nature of Injury
7 8 9
800 Head Injuries ( (not fractures) i 220 87 173
840 Fractures of skull 85 | 31 60

Total head injuries

801 Open wounds, face and neck . 73 | 42 57
804 Open wounds, lower limbs 22 | sr 22
807 Open wounds, multiple or

N.O.S. 73 438 mz

Rest 80 | Open wounds, other sites

Total open wounds (not head).

810-1 | Bruising, contusions,

haematoma : 86 72 45
841 Fractures, vertebral column 12 25 43
842 Fractures, other trunk bones . 29 25 13
843 Fractures, upper limb 86 99 69
844 Fractures, lower limb 138 | 128 | 112
845 Fractures, multiple 65 | 31 77

Total fractures (not skull only)

846-7 Dislocations, sprains os strains 46
93 Burns . 84

Rest
Other types of injury 58

Total Injuries

Table 113 shows the types of injury incurred by the chief groups of
victims of traffic accidents. Half the men involved in accidents on
railways had a principal diagnosis of fracture, the legs being most
commonly affected, and about a further 20 per cent. had head injuries,
of which a quarter were fractures of the skull. Nearly 30 per cent. of the
injured drivers of motor cycles received head injuries, fractures of the
skull and other head injuries occurring in the proportion 7:23. A further
36 per cent. had fractures, the upper and lower limbs being the most
frequently involved sites. Among pedestrians injured by motor vehicles,
33 per cent. had head injuries and 35 per cent. fractures other than of
skull. Burns formed a higher proportion of the total injuries in both
water and air transport accidents than in any other form of traffic
accident, the percentages being 10 and 8 respectively.

The proportionate annual composition of admissions attributed to
bombs and the effects of blast, gunshot and other explosive missiles is
shown in Table 114.

Taken over the seven years, the number of bomb injuries attributed
to war operations was 2:8 times those not so ascribed; corresponding

26*CMS

796 CASUALTIES AND MEDICAL STATISTICS

TABLE 114

Annual Proportionate Distribution of Admissious due to Injury by Bombs and Effect
of Blast, Gunshot and Other Explosive Missiles, among Male Service Personnel,

1940-46
M.R.C,} Proportions per 1,000 Admissions Estimated
Code External Cause t Total
Suffix 1940 | 1941 | 1942 | 1943 | 1944 | 1945 | 1946 Admissions
Due to Operations of War
4V | Bombs (including mines,
grenades, depth charges
and effects of blast) 160} 63| 41 | 8: | 566 12,360 +249
sV_ | Gunshot (including rifle,
machine gun and smali
arms) 148 10} 27 69 | 618 18,900 + 307
6V_ | Other explosives (includ-
ing mortar, cannon,
breechblock, weapon
burst and shrapnel) 123 7 10 38 | 724 25,270£355
Not due to Operations of War
av Bombs, etc., and Neficcts
of blast. 53 67 | 225 | 222 | 283 442041
5V Gunshot, etc. 1g2 | 110 | 179 | 143 | 287 9.485 tar!
6V Shrapnel, etc. 110 61 | 137 | 176 | 403 3,760 +137
TABLE 115

Proportionate Composition by Nature of Injury of Admissions due to Injury by
Bomb, Gunshot and Other Explosive Missiles. Male Service Personnel, 1940-46

External Cause of Injury

M.R.C. Bombs and Gunshot Other Explosive
Code Nature of Injury Effects of Blast Missiles
Number|
War |Not Wa War |Not Wa: War |Not War
Opera- | Opera- | Opera- | Opera- | Opera- | Opera-
tion tion tion i tion tion
800 Head Injury (not fracture) 70 38 17 32 45
840 Fracture of Skull. an 27 23 18 24
or 65 40 69
801 Open wounds, face and neck 587 94 28 g
802 Open wounds, t: ; 34 32 61 1
803 Open wounds, upper limb ia 50 52 116 129
804 Open wounds, lower limb : Jo 8 154 136
805-6 | Open wounds, with internal in-
juries to chest or
abdomen . 18 14 30
807 Open wounds, quultiple or
N.O.S.. 77 7a | tar
801-7 ‘Total open wounds (not head) . 406 m2 510
810-1 Bruising, Contusion, Haematoma 2 23 I
817-18 | Traumatic ‘Amputations . 7 28 1
841 Fracture, vertebral column i 12 3 8
842 Fracture, trunk : c 4 12 3 16
843 Fracture, upper limb 62 62 118
844 Fracture, lower limb % 95 132
845 Fracture, multiple . 42 32
841-5 | Total fractures (not skull). 248 207 326
87 Shock : 7 é 12 10 2
93 Burns . . . F ee 19 139 ir
Rest,
80-96 | Other types of injury : “5 125 86 99
80-96 | Total Injuries. . . 1,000 1,000 1,000

THE EMERGENCY MEDICAL SERVICES 797

ratios for gunshot and for shrapnel and other explosive injuries were
2-0 and 6-7. Of injuries attributed in the records to war operations
57 per cent. of the seven year total due to the effects of bombs or blast,
62 per cent. of those due to gunshot and 72 per cent. of those due to
shrapnel and other explosives caused admissions in the year 1944.
Twenty-two per cent. of bomb injuries not attributed to enemy action
occurred in each of 1942 and 1943, and a further 28 per cent. in 1944,
but 40 per cent. of shrapnel injuries caused admissions in this year
which suggests that more of such injuries should have been attributed
to war operations. In all about 56,500 missile injuries were ascribed to
war operations and 17,700 not so ascribed.

Table 115 shows a comparison of the nature of the injuries caused by
these missiles, those due to war operations being distinguished from the
others. Gunshot caused fractures of the skull rather than other types of
head injury, whereas the reverse was true for bombs and shrapnel.
Bombs and blast and shrapnel caused more open wounds of multiple
sites but gunshot wounds were more frequent in the lower limbs.

Of the injuries caused by shrapnel in war operations, 26 per cent. were
fractures other than of skull, compared with 16 per cent. of those not
stated to be due to enemy action.

Among the remaining types of external cause, included under suffixes
oX-9X, 5X and 7X-9X provide for the classification of causes about
which information is not precise. Such accidents as falls, crushing,
blows and accidents during sport would be likely to occur in civilian
life, but under Service conditions some of the injuries caused might be
more likely to result in admission to hospital whereas normally they
would be treated at home or in the Out-patients’ Department. As shown
in Table 116 it is estimated that nearly 20,000 men were admitted with
injuries received during sport during 1940-46, in addition to which a

TABLE 116

Annual Proportionate Distribution of Admissions due to Falls, Blows and other
External Causes with M.R.C. suffix oX-9X (not due to Operations of War) among
Male Service Personnel, 1940-46

M.R.C. Proportions per 1,000 Admissions Estimated
Code External Cause ‘Total
Sufhx 1940] 1941 | 1942 | 1943 | 1944 | 1945 | 1946 104e7 Admissions

4

oX Fall. 5 3 . | 107 | 132 | 274 | 191 | 161 | ror | 34 | 1,000 | 26,680+ 365

1X Crushing >) 1 | 73] 127 | 197 | 216 | 259 | 109] 19 | 1,000 | 8,545 +207

2X Blow . : . ~ | 100 | 135 | 212 | 212 | 203 99 | 39 | 1,000 | 123104248

3X Explosion {rot included | 58] 90 | 130 | 181 | 352 | 152 | 36] 1,000 | 1,385= 83

elsewhere
$ Accident during sport . | 104 | 176 | 238 | 178 | 156 | 110 | 38 | 1,000 | 19,940 +316
6X Unclassified or unspeci-
fied cause of injury
onduty . .. z 93 | 143 | 193 | 214 | 227 | 105 25 | 1,000 | 18,650+305
Other causes of injury in
the home, or elsewhere | 113 | 139 | 220 | 171 | 211 | 106 | 40 | 1,000 | 46,545 +482
> 103 | 142 | 226 | 189 | 199 | 106 35 | 1,000 | 134,055+819
ee a Pa nr en Pres (ie foes SSE Pa a ee ee ee

798 CASUALTIES AND MEDICAL STATISTICS

proportion of the 18,650 estimated admissions ascribed to suffix 6X
would be due to injuries received during physical training. Nearly a
quarter of the total injuries causing admission which were received
during sport occurred in 1942. In this year also 27 per cent. of the injuries
due to falls occurred, the estimated total number of admissions due to
this cause during 1940-46 being about 26,700. If the small number of
admissions during 1946 be deducted, the average number of admissions
over the remaining six years is nearly 21,000 a year, and the amount of
time lost to service, coupled with that during which hospital beds were
occupied suggests that every effort should be made to reduce the number
of accidents ascribed to these causes.

Table 117 shows the proportionate composition by nature of injury
of admissions attributable to falls, crushing, blows, injuries during

‘TABLE 117

Proportionate Composition by Nature of Injury of Admissions due to Falls, Blows,
Crushing, Injuries at Sport and Injuries incurred while on duty, but not otherwise

Specified, 1940-46
M.R.C. Suffix for External
M.R.C. Nature of Injury Cause (See Table 116)
Code
800 Head Injury (not facie)
840 Fracture of skull =.
Total head injuries .
801 Open wounds, face and neck
803 Open wounds .
804 Open wounds, lower limbs
807 Open wounds, multiple or
. 7 4
802, 5,6 Ones ouade: ‘other sites” 5 3 3
Total open wounds (not head) . 65 125
810-1 Bruising, Contusions,
Haematoma 5 : . 128 | 101
815-6 Crushing Injuries : 3 gr
841 Fracture, vertebral column . 25 15
Fracture, other trunk bones. 25 37
843 Fracture, upper limbs. - 202 195
844 Fracture, lower limbs
845 Fracture, multiple .
Total fractures (not skull).
846-7 Dislocations, sprains and strains
93 urns. é . 3 7
Rest, 80-96] Other types of injury
Totals.

THE EMERGENCY MEDICAL SERVICES — 799

sport and those incurred while on duty but not otherwise specified.
Twelve per cent. of the injuries caused by falls involved the head and
another 19 per cent. were dislocations, sprains and strains. Half the
crushing injuries resulted in either a fractured arm or leg, compared
with 39 per cent. in the case of falls, 25 per cent. for blows, 39 per cent. for
injuries at sport and 38 per cent. for injuries on duty. Dislocations,
sprains and strains were 33 per cent. of the injuries received during
sport.

800 CASUALTIES AND MEDICAL STATISTICS

Part II. Civilian Patients

Four main groups of civilian patients were entitled to treatment in
E.MLS. hospitals:

(a) Merchant Navy officers and men, sick and injured.

(b) Evacuee children, refugees from Gibraltar and the Channel
Islands, sick civilians moved from target areas, transferred war
workers and those in agricultural and forestry camps.

(c) Civilians, including regular Police, suffering from war injuries and
injuries incurred in the performance of Civil Defence duties.

(d) Cases of fractures and certain other types of injury occurring
among manual workers in factories and full-time Civil Defence
workers.

ADMISSIONS FOR DISEASES

In the one-fifth sample of admissions to E.M.S. hospitals 14,421
males and 8,852 females were admitted during 1940-46 for treatment of
diseases, the estimated total admission being about 72,000 men and
boys and 44,000 women and girls. The proportions admitted in individual
years from 1940 to 1946 were:

1944 | 1945 | 1946 | 1940-46

Males . 162

264

1,000
1,000

47 15
53 2

Fifty-nine per cent. of the males and 58 per cent. of the females were
admitted during 1940 and 1941; the annual proportions decreased in
1942-43, increased again in 1944 and then further declined in 1945-46, for
both sexes.

The proportionate age and sex composition of the two groups was:

All

Males

Numbers . 54 202 | 275 14,421

Proportion | peta 19 1,000
Females

Numbers 163 | 212 8,852

Proportion 18 24 1,000
Males per 100

Females. 124 | 130 163

The preponderance of males over females admitted at ages 15-54 is
attributable to admissions of merchant seamen and men engaged in
Civil Defence duties.

THE EMERGENCY MEDICAL SERVICES 801

Appendix II(a) (page 814) shows the proportions per 1,000 total
admissions for illness in each year from 1940 to 1945, the diseases in
M.R.C. numbers 00-76 being divided into 15 groups, following the
arrangement shown on pages 17-19 of the M.R.C. Classification, but
grouping together congenital malformations and diseases peculiar to the
first year of life. The groups showing the highest proportional rates for
males and females at all ages in the six years 1940-45 were as follows:

802 CASUALTIES AND MEDICAL STATISTICS

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THE EMERGENCY MEDICAL SERVICES 803

The disparity in the size of the groups of diseases is one factor in
determining their order of relative frequency. Hence it is to be expected
that diseases of the digestive system, a group covering numbers 47-55
of the M.R.C. Classification, will have a high frequency, and for males
it was the most important group in each year, accounting for from
20-26 per cent. of the annual admissions. Among females, diseases of
the digestive system were second in importance to those of the nervous
system and sense organs during 1940 to 1942 and in 1944, whereas in
1943 they were fifth in order of frequency and third in 1945. This group
accounted for percentages of the total admissions for diseases varying
from 8 per cent. in 1945 to 16 per cent. in 1941 and 1942. The most
important group responsible for females’ admissions was that affecting
the nervous system and sense organs, and the proportion of admissions
for this cause varied from 17 per cent. in 1943 up to 55 per cent. in 1945.
Infective and parasitic diseases, and diseases of the respiratory system,
of bones, joints and organs of movement, and of skin and cellular tissue
were also among the groups occurring most frequently.

Of all admissions of males for diseases of the digestive system, hernia
accounted for 39 per cent., diseases of the intestines for 20 per cent., of
stomach and duodenum for 15 per cent. and of the pharynx and oeso-
phagus for 15 per cent. Among women’s admissions for diseases of this
system, diseases of the intestines (notably appendicitis) accounted for
39 per cent., of the pharynx and oesophagus for 25 per cent. and

TABLE 118

Civilian Patients admitted to E.M.S. Hospitals, 1940-45. Proportions per 1.000
total admissions for illness in each age group, for infective and parasitic diseases,
diseases of nervous system and sense organs, and those of digestive system

Males Females
Year Age Groups Age Groups
o- | 15- | 25- | 35s- } ss- | 75 up| All | o- | rs- | 25- | 35- | ss- | 75 up| All

Infective and Parasitic

1940 | 269 | 259 | 198 | 103 | 17 — | 147 | 261 | 208 | 103 | 81 ao] — | 118
1941 250 | 306 | 280 | 135 34 — | 202 53 | 278 | 102 20 34 = ur
1942 100 | 296 | 202 | 190 or — | 205 | 250 | 186 | 167 _- or _- 135
1943 667 | 260 | 118 | 143 31 << f 3ES as or | 384 - —= = 170
1044 143 | 200 | 286 | 179 | 115 — | 202 | s00 go | 222 _ —|— 84
1945 500 | 301 | 264 | 121 73 — | 206 — | 124 | 250 63 _ _ 102

1940 | 39 | 86) 138] 176] 242] 333 | 156 | 130 | 208 | 277 | 460 | 600] 133 | 320
1941 | 71 | 83 | 150] 251 | 31x | 200 | 189 | 158 | 148 | 245 | 402 | 484 | 714 | 310

1942 200 | 111 g8 | 116 | 273 — | 123 | 250 |] 116 | 233 | 456 454 _— 253
1943 — | 123 | 219 | 161 | 187 —| 170 — | 181 — | 250 | 1,000 _- mt
1944 | 143 | 147 | 174 | 213 | 262 | — | 190 | 500 | 200] 400 | 44s | ‘54 — | 387
1945 — | 107 | 165 | 302 | 203 [1,000 | 215 | — | 250 | s00 | 749 | 77! = 415852
Digestive System
1940 15. 225 | 203 | 291 | 156 — | 251 | 217 | 201 | 173 54 — = 125
1941 | 196 | 185 | 220 | 231 | 139 | — | 203 | 368 | 206] 61 | 102 | 104] — | 164
1942 gs00 | 241 | 231 | 260 | 205 | 1,000 | 247 _ 350 67 45 _- _- 162
1943 33 260 | 237 | 262 | 187 — | 247 — | 182 77: | 125 _ _— 114
1944 | 428 | 348 | 199 | 257 | 197 | 200 | 259] —] soo] 56] 74 — | 187
1945 §00 | 252 | 290 | 215 | 171 — | 244 — | 187 = Sa mar _- 2

804 CASUALTIES AND MEDICAL STATISTICS

hernia for 13 per cent. The principal causes of admission among diseases
of the nervous system for both men and women were contained in
numbers 330-3324 of the M.R.C. Classification, the proportion of all
nervous diseases classified to these numbers being 65 per cent. for males
and 60 per cent. for females. The principal individual diseases were
anxiety states, depression and hysteria. The two main groups of infective
and parasitic diseases-causing admission of males were venereal disease
and diseases in ogo-098, particularly scabies and pediculosis, each being
30 per cent. of the total of all infective and parasitic diseases. The persons
admitted for venereal disease were mainly merchant seamen of various
nationalities.

Table 118 shows the proportionate admissions in each age group
during 1940-45. Infective and parasitic diseases formed on the whole
smaller proportions of the men’s total admissions for sickness at ages 35
and over, than at ages under 35. A similar falling off in the proportions for
digestive diseases occurred at ages of 55 and upwards. Women at ages 35
and upwards had larger proportionate rates of diseases of the nervous
system.

ADMISSIONS FOR INJURIES

Injuries to civilians are divided into two chief categories in the M.R.C.
Classification:

(i) Those directly due to operations of war (Prefix VV) including

(a) accidents due to home-guard or fire-guard practices but not
other accidents while on civilian war duties unless during
actual operations of war.

(b) all kinds of injury or poisoning attributable to enemy action
but not to civil rioting.

(ii) Those not stated to be due to operations of war (No prefix).

Since assignment between these two categories in the E.M.S. coding
depended on the information given in the case histories, it is possible
that some accidents actually due to war operations, especially those due
to bombs or the effects of blast, have been included erroneously in the
second group because they were not stated in the medical records to
have been due to enemy action.

The number of civilians in the sample admitted for injuries was
19,575, the estimated total admissions being about 98,000. The distribu-
tion between males and females, according to whether the accident was
stated to be due to war operations or not was as follows:

THE EMERGENCY MEDICAL SERVICES 805

Stated to be due to War | Not stated to be due to
Operations War Operations

Number in Estimated Totals Number in Estimated Totals

Samples
46,515 +482 2,001 10,005 +2:
40,215 +448 228 1,140+ 7

86,730 +655 | 2,229 11,145 +528

The ratio of male to female casualties due to war operations was 1:2,
and for those not so ascribed, 8-8.

TABLE 119

Civilian Casualties due to Operations of War.
Admissions during 1940-1945, by war-time duty,
and childhood or adult status.

Males and Males 15 Females 15
CLASS OF PERSON Females Years and Years and All
INJURED under 15 over and over
Ordinary Civilians Ft 1,441 6,991 71342 15,774
Civil Defence Personnel . 1 1,002 49 1,052
Merchant Navy Personnel _ 517 519
Totals. f 5 1,442 8,510 17,345
Proportion 2 5 83 491 1,000

The aggregate civilian admissions due to operations of war have been
sub-divided in Table 119 according to whether the patient was a merch-
ant seaman (including passengers carried in merchant ships), a member
of the Civil Defence services or an ordinary civilian. In the latter class
there were 1,441 children under 15, 6,991 adult males and 7,342 adult
females. Among civil defence personnel more than 20 times as many
men as women were admitted, the nature of their duties exposing
them to greater risk of injury by enemy action. Of every 1,000 persons
with injuries due to war operations, 83 were children under 15, 491
adult males and 426 adult women.

The annual admissions due to enemy action of these three groups of
patients are shown in Table 120. The greatest sample numbers of
ordinary civilians to be admitted to E.M.S. hospitals were 5,849 in 1940
and 4,167 in 1941, compared with 3,674 in 1944, at the time of the Vz
and V2 missiles.

806 CASUALTIES AND MEDICAL STATISTICS

‘TABLE 120

Civilian Casualties due to Operations of War. Annual Admissions during 1940-45,
by war-time duty and childhood or adult status

Males and
Females | Males, 15 years| Females, 15 All
lunder 15 years} and over and over
1940 Ordinary Civilians 483 2,740 2,626 5,849
Civil Defence 365 7 382
Merchant Navy . -_ 241 1 242
483 3,346 2,644 6,473
1941 Ordinary Civilians 324 2,151 1,692 4,167
Civil Defence 1 322 16 339
Merchant Navy . _ 163 1 164.
325 2,636 1,709 4,670
1942 Ordinary Civilians 81 361 312 754
Civil Defence . _ 130 2 132
Merchant Navy . a 53 = 53
81 544 314 939
1943 Ordinary Civilians 79 278 307 664
Civil Defence . _ 84 3 87
Merchant Navy . _ 28 = 28
79 390 310 779
1944 | Ordinary Civilians 376 1,264 2,034 3,674
Civil Defence —_ 97 i 108
Merchant Navy . _ 23 _— 23
376 1,384 2,045 3,805
1945 | Ordinary Civilians 98 197 371 666
Civil Defence . _ 4 _ 4
Merchant Navy . _ 9 x, 9
98 210 371 679

The civilian admissions for injury were attributable to external
causes according to the list of suffixes on p. 740 as follows:

Suffix | Males | Females

Transport . , : 5 5 o9 1,096 83
Occupational or due to missiles, etc. | oV-9V 8,751 | 7,979
Falls, blows and miscellaneous . | oX-9X 1,457 209

Totals . : “ 2 a 11,304 | 8,271

Ninety-seven out of every 1,000 males were admitted following a
transport injury, and 10 out of every 1,000 females. Of 1,096 men
admitted for this type of accident, 670 or 61 per cent. had received

807

THE EMERGENCY MEDICAL SERVICES

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808 CASUALTIES AND MEDICAL STATISTICS

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810 CASUALTIES AND MEDICAL STATISTICS

injuries in water transport, and 112 or ro per cent. were drivers of motor
cycles injured on the roads. Table 121 shows the annual admissions for
transport accidents, whether ascribed to war operations or not, according
to external cause. It will be noticed that the number of admissions for
water transport accidents due to operations of war declined from 229 in
the 1940 sample to 8 in 1945. Several women who received injuries in
air transport accidents were engaged in ferrying aircraft from the
factories to the flying stations.

Among injuries due to the external causes listed in M.R.C. suffixes
oV-9V, the greatest number were due to bombs and effects of blast.
Table 122 shows that 8,431 males and 7,934 females in the sample had
been injured in this way by enemy action; the corresponding estimated
total admissions being about 42,000 males and 40,000 females. Among
males admitted for injuries due to bombs or effects of blast during the
six years 1940-45, 39 per cent. and 31 per cent. entered hospital in 1940
and 1941 respectively, the corresponding percentages of women’s
admissions being 35 per cent. and 23 per cent. Only 18 per cent. of the
males’ admissions occurred in 1944 compared with 28 per cent. of
the women’s.

The numbers of admissions attributable to other external causes are
shown in Table 123. Among men’s admissions stated to be due to
operations of war, accidents on duty formed the largest group, falls
being the next most important cause. Falls were also responsible for
33°5 per cent of men’s admissions in this group not ascribed to operations
of war, and were the chief cause of women’s admissions, whether due
to war operations or not. If all thirty external causes of injury be
considered together the main causes in descending order of magnitude
were:—

Percentage of all males

Males admitted for injuries
4V Bombs and effects of blast. 8,471 5
8 Water transport . 670 6
OX Falls. Ohara - 473 4
6X Accidents on duty . . 294 3
9X Unspecified accidents . 231 2
2X Blows . ‘ " + 145 I
Percentage of all females
Females admitted for injuries
HV Bombs and effects of blast. 7,939 96
OX Falls. ; 85 1

Table 124 shows the nature of the injuries for which civilian casualties
were admitted to hospital each year, a distinction being made between

811

THE EMERGENCY MEDICAL SERVICES

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812 CASUALTIES AND MEDICAL STATISTICS

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THE EMERGENCY MEDICAL SERVICES 813

those which were stated to be due to operations of war and the remainder.
The types of injury which occurred most frequently and their propor-
tionate rates as shown in Table 124 were as follows:

Attributed to War Operations Not Attributed to War Operations
Males

Multiple open wounds . . 208 Head injuries, including
Head injuries, including fractured skull . . 201
fractured skull . . . 165 Fractures of lower limbs . 161
Open wounds, face and neck. 77 Bruising, contusion and
Haemorrhage, shock, etc. . 74 haematoma . . 82
Fractures of upper limbs . 68
Females
Multiple open wounds . 225 Head injuries, including
Head injuries, including fractured skull : . 224
fractured skull : . 167 Fractures of lower limbs. 163
Haemorrhage, shock . - 165 Bruising, contusion and
Open wounds of face and haematoma . i . 123
neck 2 x . 88 Burns and scalds ‘ - 97

The distribution of days of in-patient treatment for casualties suffering
only from shock without mention of any other disease or injury was as
follows:

Days of In-patient Treatment

56-|or up| All

2/1 1] 477 | 6 days
Females S31 74 13 8 7 |1,001 | 7 days
9 8 | 1,478 | 7 days

Fifty-four per cent. of the patients were in hospital for only one or
two days. The average period of in-patient treatment for men was 6 days
and for women 7 days.

814 CASUALTIES AND MEDICAL STATISTICS

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822 CASUALTIES AND MEDICAL STATISTICS

Conclusion

In hospital morbidity statistics there are, among others, three groups
which merit consideration:

(i) The number of admissions and the conditions causing them,
irrespective of whether the same person appears more than once.

(ii) The number of different individuals who are hospitalised,
irrespective of the number of times each one is admitted.

(iii) The total number of different morbid conditions and the contri-
bution of each to the total pool of hospital morbidity.

In this study only the first of these groups has been considered. In the
material available, for second or higher order admissions the envelopes
containing the case histories were pinned together. Apart from the likeli-
hood of their becoming detached, there was the possibility of error in
the alphabetical order of filing, especially where names were identical
and only regimental numbers differed, hence it will be apparent that
there would have been considerable difficulty in obtaining reliable
results as to the number of different individuals hospitalised. With the
more widespread use of the unit system of keeping medical records and
the increased efficiency in record departments, it should be possible to
provide valuable information on the second point listed above.

The third item is also one which presents some difficulty. On the
E.MLS. record cards provision was made for recording four diagnoses,
and instructions were given that any further pathological conditions
should be recorded on the back of the card. It was found that in this way,
where the hospital notes were copious, that as many as eleven conditions
might be recorded, but how far some of these should be regarded as
symptomatic of others would be difficult to say. A clear distinction
would also need to be drawn between morbid conditions found in
hospital patients and morbid conditions for which treatment was given
during the period of in-patient stay.

Even allowing for the war-time difficulties experienced by all
working in hospitals, it is apparent that the divergence in the complete-
ness and quality of clinical notes is very great. One of the principal
difficulties in this work is the interpretation of medical reporting, and
experience has suggested that there is a tendency in case records for
emphasis to be laid on what requires treatment, rather than to record all
that the patient is suffering from with a view to building up a picture
of morbidity in hospitalised patients, related to underlying causes. The
figures and percentages shown in Table 78 on page 747 have an interest
in this connexion. Since it is probable that most head injuries are
accompanied by some degree of concussion, the proportions here seem
to be small especially since they are related only to those cases in which

THE EMERGENCY MEDICAL SERVICES 823

multiple causes are reported and not to all head injuries. Thus in cases
of bruised scalp the secondary diagnosis was concussion in 75 per cent.
of the cases, compared with 36 per cent. and 38 per cent. in fractures of
the vault and base respectively, suggesting that in the former case it
was on concussion that the treatment was concentrated, whereas in the
latter emphasis was on treating the fracture. Similarly the highest
proportions of mental diseases are shown here as sequelae of unspecified
forms of head injury, suggesting that it was for the mental condition,
rather than for the injury, that treatment was required. From the
clinician’s point of view the condition requiring treatment is undoubtedly
the most important, and it has considerable value also for the hos-
pital administrator. From the rather wider aspect of preventive
medicine, complete assessment of morbidity is more important, but for
this it is essential that underlying causes should also be considered.
One of the problems that emerges from the present study is how far it
is possible accurately to obtain the two purposes simultaneously and
with a minimum of effort.

It seems that a preliminary to good statistics of hospital-treated
sickness is an improvement in medical records. For collecting statistical
material for tabulation by a central statistical office, a form which relies
as little as possible on writing and in which every section requires some
answer seems the best method; this avoids the impossibility of telling
whether a blank denotesthat theclinician has made a certain examination
and found nothing adverse, or whether he has not made the examination
at all. Time and labour may be saved if the form of the statistical record
is followed in designing the front sheet of the case history.

A further vexed question is whether or not any useful purpose is
served by asking the patient’s occupation. The kind of replies received in
the follow-up of fracture cases showed the great difficulty of associating
the nature of a disease or injury with occupation. In many cases it is
impossible to get an exact statement, especially when the patient himself
is unable to answer questions; many wives, for example, do not know
what their husband’s work is, but only who he works for. To elicit a
satisfactory reply the services of a trained investigator are needed in
which case it is doubtful if the results justify the expense. In so far as
occupation can be used as an indication of social status its recording
could be useful as some deductions might be made about the connexion
between social class and hospitalised sickness. But to determine whether
or not a certain occupation has a particular risk, it seems better to start
with a group of people following that occupation rather than to hope that
hospital statistics will throw some light on the question.

In presenting information about periods of in-patient stay, all cases
in which a complication or other morbid condition was mentioned have
been excluded, and the median has been given rather than the mean as

824 CASUALTIES AND MEDICAL STATISTICS

not being so influenced by a few excessively short or unduly long stays.
In future studies further experiments will need to be made before the
most satisfactory method of recording this information can be evolved.

Little attention has been paid here to deaths among E.M.S. hospital
patients, and in general some difficulty is experienced in obtaining precise
information as to the cause of death as stated by the certifying medical
practitioner. The whole question of case fatality rates in hospital
patients is one requiring research; to take the number of deaths occurring
among patients admitted for certain diseases overlooks the possibility of
death being due to an intercurrent cause.

In conclusion it may be stated that since hospital statistics are in their
infancy, all that can be done at present is to make available such informa-
tion as can be put together, so that the magnitude and difficulties of the
problems involved may inspire the finding of a solution.

REFERENCES

Annan, J. H. (1945), Lancet, I, 174.

Brooke, E. M. (1945), Brit. Med. J., 1, 259; (1946), Brit. Med. J., II, 491;
(1950), Brit. Med. J., I, 560.

Bradley, W. H. (1944), Monthly Bulletin of Min. of Health, 3, 46. H.M.
Stationery Office, London.

Cullinen, E. R. (1939), Proc. R. Soc. Med., 32, 933-

Deardorff, M. R. and Fraenkel, M. (1942, 1943). An analysis of 576, 623
patients discharged from hospitals in New York in 1933. Hospital Dis-
charge Study,1933, I and II. Welfare Council of New York City, New York.

Dible, J. H., McMichael, J. and Sherlock, S. P. V. (1943), Lancet, II, 402.

Greenwood, M. (1944), Practitioner, CLIII, No. 918, 323.

Health, Ministry of (1950), Report for the year ended 31st March, 1949,
including the Report of the Chief Medical Officer on the State of the Public
Health for the year ended 31st December, 1948. H.M. Stationery Office,
London.

Lancet (1942), Soldier’s Foot, II, 312.

Lescher, G. (1944), Brit. Med. J., 1, 554.

Linsey, A. A. (1943), Proc. R. Soc. Med., 37, 165.

Mackay, D. (1951), Hospital Morbidity Statistics: Studies on Medical and
Population Subjects, No. 4. H.M. Stationery Office, London.

Maitland, E. M. and Winner, A. L. (1939), Lancet, I, 161.

Medical Research Council (1944). A Provisional Classification of Diseases
and Injuries for use in compiling Morbidity Statistics, Sp. Rep. Ser.,
No. 248.

Registrar General (1940-44), Weekly Returns. H.M. Stationery Office,
London; (1949-50), Quarterly Returns, Nos. 402, 403, 404, 405, Tables
A-H. H.M. Stationery Office, London.

Stocks, P. (1949), Sickness in the Population of England and Wales in 1944-47:
Studies on Medical and Population Subjects, No. 2. H.M. Stationery Office,
London.

THE EMERGENCY MEDICAL SERVICES 825

War Office (1948), Statistical Report on the Health of the Army, 1943-45.
H.M. Stationery Office, London.

Witts, L. J. (1944), Brit. Med. J., I, 739.

World Health Organization (1948), Manual of the International Statistical
Classification of Diseases, Injuries and Causes of Death, 1. H.M. Stationery
Office, London.

biatizes ty GOORTe

ANNEXURE

Strength and Casualties
of the

Armed Forces and Auxiliary Services
of the United Kingdom

1939 to 1945

Presented by the Prime Minister and the Minister of Defence
to Parliament by Command of His Majesty
June 1946

H.M.S.O.
Cmd. 6832 (Out of print)

27°CMS

Digitized by Google

INTRODUCTION

This paper gives statistics of the number of men and women who
served in the Armed Forces and auxiliary services of the United King-
dom and of the casualties suffered during the war. The figures relate
only to British subjects usually domiciled in Great Britain and Nor-
thern Ireland and to those British subjects and other persons elsewhere
who individually enlisted and served in the Armed Forces and Auxiliary
Services of the United Kingdom. They do not include men and women
who served in units and contingents of His Majesty’s Forces, other than
those of the United Kingdom, or in Allied units and contingents under
British or Allied Commands.(*)

SECTION I.—NUMBERS SERVING IN THE ARMED
FORCES AND AUXILIARY SERVICES OF THE
UNITED KINGDOM

Armed Forces

2. On August 31, 1939, the strength of the Armed Forces of the
United Kingdom (Royal Navy, Army and Royal Air Force) was
681,000 men. Including reservists mobilised, a further 5,215,000
men were taken into the Services between August 31, 1939 and
June 30, 1945, making a total of 5,896,000 men who served in the
Armed Forces during the war. Of this total 923,000 men served in the
Royal Navy, 3,788,000 in the Army, and 1,185,000 in the Royal Air
Force.(?) This intake was sufficient, not only to meet casualties and
discharges on medical and other grounds, but also to raise the total
serving strength of the Armed Forces from 681,000 men at the out-
break of the war to 2,223,000 by June 1940, and to a peak of 4,683,000
men in June 1945.

3. Most of these men were drawn from the younger age groups
between 18 and 30. Three out of every five men born between 1905 and
1927 and seven out of every ten born between 1915 and 1927 served
in the Armed Forces.

Women’s Auxiliary Services

4. The strength of the Women’s Auxiliary Services (Women’s Royal
Naval Service, Auxiliary Territorial Service, Women’s Auxiliary Air

(4) The total strength of the British Commonwealth and Empire Armed Forces
(excluding Women’s Services) was 8,845,000 at the middle of 1945. If allowance is
made for the number who became casualties and who were discharged on medical and
other grounds the total number of men who served during the war was over 10 millions.

(?) To avoid duplication, men or women who transferred from one Service to another
have been excluded from the intake figure of the Service to which they were later
transferred.

829

830 CASUALTIES AND MEDICAL STATISTICS

Force and the Nursing Services) at the beginning of the war was
21,000.

Between August 31, 1939 and June 30, 1945, 619,000 women entered
the Women’s Auxiliary Services, so that a total of 640,000 women served
during the war. From the beginning of the war to June 30, 1945,
86,000 women served in the Women’s Royal Naval Service, 307,000 in
the Auxiliary Territorial Service, 219,000 in the Women’s Auxiliary Air
Force and 28,000 in the Nursing Services.(") This rate of intake made
it possible to raise the total serving strength of the Women’s Auxiliary
Services from 21,000 at the beginning of the war to a maximum of
466,000 in 1944. Although the mobilization of women was directed
mainly to the replacement of men in industry, one in every nine women
born between 1915 and 1927 served in the Women’s Auxiliary Services.

Other Services

5. In addition to the men and women serving in the Armed Forces
and the Women’s Auxiliary Services, a large number of men served in
the Merchant Navy and many men and women were recruited for
service, whole-time or part-time, in Civil Defence,(?) the Royal Observer
Corps, and the Home Guard.

6. Whole-time—At June 1944, when the strength of the Armed
Forces was 4,544,000, there were 417,000 men serving whole-time in
Civil Defence, the Merchant Navy and the Royal Observer Corps. In
addition to the 466,000 women in the Women’s Auxiliary Services at
this date there were 61,000 women serving whole-time in Civil Defence
and the Royal Observer Corps.

7. Part-time —At June 1944, there were 3,002,000 men giving part-
time service. Of this total 1,253,000 were in Civil Defence (excluding
Fire Guards), 1,727,000 in the Home Guard and 22,000 in the Royal
Observer Corps. In addition there were 391,000 women performing
part-time duties in these three Services.

Peak of Mobilization

8. The peak of mobilization of the Armed Forces, Auxiliary and other
Services taken together was reached in June 1944, when the liberation of
Europe began. The numbers actually serving at that date were as
follows:

(*) Queen Alexandra’s Royal Naval Nursing Service, Queen Alexandra's Imperial
Military Nursing Service, Territorial Army Nursing Service, Princess Mary’s Royal
Air Force Nursing Service and members of Voluntary Aid Detachments serving with
the Armed Forces.

(?) Civil Defence General Services (including the Casualty Services and the Civil
Defence Reserve), National Fire Service, Regular Police and Auxiliary Police. Members
of the Fire Guard service, other than those engaged in supervisory duties, are excluded.

ANNEXURE 831

Men Women
Armed Forces Thousands | Women’s Auxiliary Services Thousands
Royal Navy a . 790 W.R.N.S. % , 74
Army 5 “é a 2,742 ATS. . A . 199
Royal Air Force . e 1,012 W.A.A.F. : . 174
Nursing Services 4 19
Total ‘, . 45544 Total. : 466
Other Services Other Services
Whole-time Whole-time
Civil Defence. 5 231 Civil Defence . 58
Merchant Navy :: 180 Royal Observer Corps 3
Royal Observer Corps . 6
Total é as 417 Total . S 61
Part-time Part-time
Civil Defence a a 1,253 Civil Defence . 358
Royal Observer Corps . 22 Royal Observer Corps 2
Home Guard a 5 1,727 Home Guard . 31
Total 7 5 3,002 Total . Z 391

SECTION IIL—STRENGTH OF INDIVIDUAL SERVICES

Armed Forces

g. Table I shows the expansion of the Armed Forces of the United
Kingdom from 1939 to 1945. The figures include men locally enlisted
abroad in United Kingdom Forces (of whom there were 30,000 at June
1945) and men from overseas who enlisted in the United Kingdom to
serve in the United Kingdom Forces.

STRENGTH OF THE ARMED FORCES OF THE UNITED KINGDOM

TABLE 1 Thousands
End of month Total Royal Navy Army Royal
Armed Forces Air Force
August, 1939 . 681 161 402 118
June, 1940 . 2,223 276 1,656 291
June, 1941 . 3,291 405 2,221 665
June, 1942 . 3,815 507 2,468 840
June, 1943 . 4,332 671 2,692 969
June, 1944 . 45544 790 2,742 1,012
June, 1945. 4,683 789 2,931 963

10. The figures relate only to men actually serving at the dates shown,
They exclude men:

(a) on deferred service
(b) on reserve

832 CASUALTIES AND MEDICAL STATISTICS

(c) temporarily released to industry or released on compassionate
grounds

(d) reported prisoners of war or missing

(e) members of the Home Guard.

11. The total strength of the Armed Forces reached its peak of
4,683,000 in June 1945. Of this total strength 666,000 were engaged in
the war against Japan in South-East Asia and the Far East and 4,017,000
were serving in other overseas theatres and at home. The numbers in
each service were:

Against Japan Others
Royal Navy ‘ é . 224,000 565,000
Army 2 uy . + 315,000 2,616,000
Royal Air Force . ; + 127,000 836,000

12. Royal Navy.—The strength of the Royal Navy rose from 161,000
at the beginning of the war to 789,000 in June 1945. The figures given
include the Royal Marines, the Naval Air Arm and merchant seamen
serving with the Royal Navy on special agreements (T.124 agreements
and variants). In June 1945, the strength of the Naval Air Arm was
79,802, of whom 8,350 were trained aircrew and 4,283 aircrew in
training. The strength of the Royal Marines was 78,000 and the number
serving under T.124 agreements (and variants) was 13,000.

13. Army.—The strength of the Army was raised rapidly from
402,000 at August 31, 1939 to 1,656,000 in June 1940, and then in-
creased each year to a peak of 2,931,000 in June 1945. This latter figure
included some 108,000 men who were formerly prisoners of war in
Germany. The figures for the Army exclude the British component
of the Indian Army amounting to about 18,000 at June 30, 1945. At the
end of the war over one and three-quarter million men of the Army were
serving abroad.

14. Royal Air Force—The strength of the Royal Air Force was
118,000 at the beginning of the war. This was raised steadily to a peak
of 1,012,000 by the middle of 1944 declining slightly to 963,000 in June
1945. The numbers shown exclude all Dominion Air Forces serving
under their own Commands or placed at the disposal of the Royal Air
Force and also exclude Allied Air Forces serving under their own or
under British Commands. At the end of the war 316,000 men of the
Royal Air Force were serving abroad.

Women’s Auxiliary Services

15. The total strength of the Women’s Auxiliary Services, including
the Nursing Services, rose steadily from 21,000 at the beginning of the
war to 466,000 at the middle of 1944. At this date there were 74,000

ANNEXURE 833

women serving in the Women’s Royal Naval Service, 199,000 in the
Auxiliary Territorial Service, 174,000 in the Women’s Auxiliary Air
Force, and 19,000 in the Nursing Services. About 37,000 members of
the Women’s Services were serving abroad at the end of the war.

STRENGTH OF THE WOMEN’S AUXILIARY SERVICES OF THE UNITED KINGDOM

TABLE 2 ‘Thousands
End of month Total | W.R.N.S.| A.T.S. | W.A.A.F. | Nursing
Services
August, 1939. : 21 _ 18 2 I
June, 1940 . . 56 6 32 12 6
June, 1941. f 105 15 43 37 10
June, 1942 . ef 307 29 140 126 12
June, 1943. A 461 53 210 182, 16
June, 1944 . : 466 74 199 174 19
June, 1945 . : 437 72 191 153 21
Civil Defence

16. Grouped under this heading are the Civil Defence General
Services (including the Casualty Services and the Civil Defence
Reserve), National Fire Service, Regular Police and Auxiliary Police.
These services exclude members of the Fire Guard Service other than
those engaged in supervisory duties.

The total strength of the Civil Defence Services was raised rapidly
by the middle of 1940 to 1,742,000, of whom 349,000 were serving
whole-time. The number of men serving whole-time increased to
330,000 in 1941 and then declined to 231,000 by the middle of 1944.
The number of both men and women serving part-time, however, rose
between 1940 and 1944 so that the total strength of the Civil Defence
Services reached its peak of 1,900,000 at the middle of 1944.

STRENGTH OF THE Ci1vIL DEFENCE SERVICES OF THE UNITED KiNGDOM

TABLE 3 ‘Thousands
Total Whole-time Part-time
End of
month Total | Men | Women| Total | Men | Women| Total | Men | Women
June, 1939 . 83 83 — 83 83 -—- 1] — =

June, 1940 . | 1,742 | 1,401 | 341 349 | 296 53 |1,393 | 1,105 | 288
June, 1941 . | 1,834 | 1,487 | 347 390 | 330 60 | 1,444 | 1,156 | 288
June, 1942 . | 1,728 | 1,399 | 329 391 | 311 80 | 1,337 | 1,088 | 249
June, 1943 . | 1,881 | 1,472 409 331 260 71 | 1,550 | 1,212 338
June, 1944 . | 1,900 | 1,484 416 289 231 58 | 1,611 | 1,253 358
June, 1945(?) | 411 369 42 131 116 15 280 253 27

(?) Considerable numbers were enrolled for part-time duty, but only limited numbers
were required to perform regular duties in June 1939.

(?) Only the National Fire Service, Regular Police and Auxiliary Police were still
performing active duties at the end of June 1945.

834 CASUALTIES AND MEDICAL STATISTICS

Home Guard and Royal Observer Corps

17. The appeal for men to enrol in the Local Defence Volunteers,
which was re-named the Home Guard, was made in May 1940. By the
end of June 1940, the strength of the Home Guard was 1,456,000. This
strength was raised to 1,784,000 by the middle of 1943 and maintained
at about one and three-quarter million until the end of 1944. In 1943
women were enrolled in the Home Guard for non-combatant duties
and 31,000 were serving at the middle of 1944.

The Royal Observer Corps was created to ensure the rapid detection
of enemy aircraft attacking the United Kingdom and to provide navi-
gational help to the Royal Air Force operating from the United King-
dom. By June 1940, there were 28,000 men and women serving in the
Royal Observer Corps, of whom 2,000 were serving whole-time and
26,000 part-time. The strength was increased to 33,000 in 1941 and
maintained at about this level throughout the war.

STRENGTH OF THE Home GuARD AND Royat OBSERVER Corps

TABLE 4 ‘Thousand
Home Guard Royal Observer Corps
pea a aan
End of month Whole-time Part-time

Men | Women| Total
Men | Women| Men | Women

June, 1940. | 1,456 _- 28 2 _ 26 _
June, 1941. | 1,603 —, 33 4 = 29 _
June, 1942. | 1,565 _ 34 5 i 28 1
June, 1943. | 1,784 7 33 6 1 25 1
June, 1944. | 1,727 31 33 6 3 22 2

SECTION III—CASUALTIES

18. The figures given in this section relate to the casualties suffered
during the war by the Armed Forces and auxiliary services enumerated
in Section II and to casualties suffered by the civilian population of the
United Kingdom. In the case of the Armed Forces, casualty figures are
subject to continuous revision and a final statement cannot be issued
until the fate of all men still reported missing is determined. Four
categories of casualties to the Armed Forces and the Women’s Auxiliary
Services are distinguished—killed, missing, wounded and prisoners of
war.

(a) Killed. The numbers recorded as killed include those who
have died of wounds or injuries, those missing presumed dead and
those who have died in captivity. The Royal Navy include deaths
from disease attributable to war service and the Royal Air Force

ANNEXURE 835

include suicides. All other deaths from natural causes are ex-
cluded.(*)

(b) Missing. Men reported missing and then subsequently re-
ported killed, wounded or prisoners of war have been transferred
from ‘missing’ to the other category. The figures for missing
shown in the tables include men reported missing who sub-
sequently rejoined their units as well as those who were still
missing on February 28, 1946.

(c) Wounded. The number of wounded recorded by the Army
is limited to injuries classified as battle casualties, which are
defined as comprising injuries caused by enemy action, accidental
injuries occurring in action or in proximity to the enemy and in-
juries caused by fixed apparatus laid as defences against the
enemy. The figures relate to wounds requiring treatment at a
hospital or field dressing station. The other two Services use the
term in a wider sense which embraces all injuries sustained on war
service. The Royal Air Force also include accidents occurring

during training. The figures for all Services exclude absence from
duty due to sickness.

(d) Prisoners of War. The figures include men interned in
neutral countries. They also include prisoners of war who have
been repatriated or who have escaped, but they exclude prisoners
who have died in captivity. Reported deaths in captivity are
transferred from ‘prisoners of war’ to ‘killed’. For prisoners in
Europe the figures are based partly on official notifications received
from Germany and Italy. For prisoners in Japanese hands the
figures are based partly on official notifications and partly on
information received from prisoners themselves.

19. The figures relate to the gross number of casualties and not to
the number of men who became casualties. A man who was reported
missing, wounded or prisoner of war more than once has been counted
as a casualty on each occasion so reported. Men reported missing or
prisoners of war are deducted from the figures of strength when so
reported and are included again in the figures of strength if and when
they rejoin their units.

20. The total casualties suffered during the war by the Armed
Forces, the Auxiliary Services and the civilian population of the United
Kingdom were 950,794. Of these 357,116 were killed, 369,267 were
wounded, 178,332 were prisoners of war or internees and 46,079 were
missing.

(2) In addition to the casualty figures given in Table 5; the following numbers of men
died from natural causes during the war while serving in the Armed Forces: Royal
Navy 6,950, Army 19,935, Royal Air Force 4,386, Total 31,271.

836 CASUALTIES AND MEDICAL STATISTICS

CASUALTIES SUFFERED DURING THE WAR BY THE ARMED FORCES, THE
AUXILIARY SERVICES AND THE CIVILIAN POPULATION OF THE UNITED KINGDOM
FROM SEPTEMBER 3, 1939 TO AUGUST 14, 1945 AS REPORTED TO FEBRUARY 28, 1946

TABLE 5 Number
Merchant
Armed | Women's| Home | Navy and
Total Forces | Auxiliary | Guard Fishing | Civilians
Services Fleet
Killed . 357,116 | 264,443 624 1,206 | 30,248 | 60,595
Missing. - | 46,079(7)| 41,327 98 oe 4,654 =
Wounded . + [369,267 | 277,077 744 557 4,707 | 86,182
Prisoner of war
and internees . | 178,332 | 172,592 20 _ 5,720 (?)
Total. - 950,794 | 755,439 1,486 1,763 | 45,329 | 146,777

(?) Including 6,244 still missing at February 28, 1946 and 39,835 who rejoined their
units.

(?) The number of United Kingdom civilians interned in enemy occupied countries
is not known.

Armed Forces

21. Table 6 shows the casualties to each of the three Services of the
Armed Forces of the United Kingdom() during the war. The Royal
Navy suffered 73,642 casualties including 50,758 killed and 14,663
wounded. The 569,501 casualties to the Army included 144,079 killed
and 239,575 wounded. In the Royal Air Force total casualties amounted
to 112,296, including 69,606 killed and 22,839 wounded.

CASUALTIES TO ALL RANKS OF THE ARMED FORCES OF THE UNITED
KINGDOM DURING THE WAR AS REPORTED TO FEBRUARY 28, 1946

TABLE 6 Number
Total Royal Navy Army Royal
Air Force

Killed... 264,443 50,758 144,079 69,606
Missing(?) : 41,327 820 33,771 6,736
Wounded : 277,077 14,663 239,575 22,839
Prisoners of war 172,592 7,401 152,076 13,115
Total . 7551439 73,642 569,501 112,296

(7) Including the following who were still missing on February 28, 1946; Royal
Navy 340, Army 2,267, Royal Air Force 3,089; Total 5,696.

22. In Tables 7 and 8, the casualties in the war against Japan are
distinguished from casualties in the war against Germany and Italy.

(@) The figures include casualties to men from overseas serving in the United
Kingdom Forces, in particular from Newfoundland and Southern Rhodesia. They
exclude casualties to the Armed Forces of the Dominions, India and the Colonies.
Casualties to all ranks of the Armed Forces of the Dominions, India and the Colonies
reported up to the end of the war were 490,768, of whom 108,929 were killed, 37,805
missing, 197,980 wounded and 146,054 prisoners of war

ANNEXURE 837

They show that the Armed Forces suffered 90,332 casualties in the war
against Japan—about 12 per cent. of the total casualties of 755,439.

CASUALTIES TO ALL RANKS OF THE ARMED Forces OF THE UNITED KINGDOM
IN THE WaR AGAINST GERMANY, AS REPORTED TO FEBRUARY 28, 1946

TABLE 7 Number
Total Royal Navy Army Royal
Air Force

Killed. ; 234,475 46,911 121,484 66,080
Missing(’) : 35,075 416 29,255 5,404
Wounded 3 260,548 14,360 224,427 21,761
Prisoners of war 135,009 5,518 119,764 9,727
Total . 665,107 67,205 494,930 102,972

(*) Including the following still missing on February 28, 1946: Royal Navy nil,
Army 671, Royal Air Force 2,109; Total 2,780.

CASUALTIES TO ALL RANKS OF THE ARMED Forces OF THE UNITED KINGDOM
IN THE WaR AGAINST JAPAN, AS REPORTED TO FEBRUARY 28, 1946

TABLE 8 Number
Total Royal Navy Army Royal
Air Force

Killed .. 29,968 3,847 22,595 3,526
Missing(?) - 6,252 404 4,516 1,332
Wounded if 16,529 303 15,148 1,078
Prisoners of war 37,583 1,883 32,312 3,388
Total . 90,332 6,437 74,571 9,324

() Including the following still missing on February 28, 1946: Royal Navy 340,
Army 1,596, Royal Air Force 980; Total 2,916.

23. Table g shows the total number of prisoners of war in each of the
Services reported captured in the war against Germany and against
Japan and the numbers reported killed or died in captivity. The total

‘TOTAL NUMBER OF PRISONERS OF WAR OF THE ARMED FORCES OF THE UNITED
KINDGOM CAPTURED BY THE ENEMY AS REPORTED TO FEBRUARY 28, 1946

TABLE 9 Number
Total Royal Navy Army Royal Air
Force
Captured by Germany and
Italy
Total reported captured 142,319 5,629 126,811 9,879
Killed or died in
captivity s . 7,310 MII 7,047 152

Captured by Japan
Total reported captured 50,016 2,304 42,610 5,102
Killed or died in

captivity : . 12,433 421 10,298 1,714

838 CASUALTIES AND MEDICAL STATISTICS

number of prisoners captured by Germany and Italy was 142,319, of
whom 7,310 died in captivity; but of a total of 50,016 prisoners captured
by Japan, 12,433 died in captivity.

The difference between the total number of prisoners captured and
the number who died in captivity is identical with the numbers shown
as prisoners of war in Tables 7 and 8, in which those who died in
captivity are included in the numbers killed.

Women’s Auxiliary Services
24. The Women’s Auxiliary Services suffered 1,486 casualties.
Of these 624 women were killed and 744 wounded.

CASUALTIES TO THE WOMEN’S AUXILIARY SERVICES DURING THE WAR AS
REPORTED TO FEBRUARY 28, 1946

TABLE 10 Number
Auxiliary
Women’s Territorial Women’s
Total Royal Naval | Service and Auxiliary
Service Army Air Force
Nursing
Services
Killed . ; f és 624 335 187
Missing F: > . 98 94(*) 4
Wounded. a Z 744 302 420
Prisoners of war. g 20 20 _
Total . 3 a 1,486 751 611

() Including 18 women who were still missing at February 28, 1946.

Civil Defence and Civilian Casualties

CasuaLTiEs TO UNITED KINGDOM CIVILIANS DUE TO ENEMY ACTION AS
REPORTED TO JULY 31, 1945
TABLE 11 Number

Casualties to Civil
Defence workers(*) on

Total Civilian Casualties duty (included in
civilian casualties)
Child- | Un-
Total | Men |Women| ren _ | identi- | Total | Men |Women
under | fied
16
Killed and
missing be-
lieved killed | 60,595 | 26,923 | 25,399 | 7,736 $37 | 2,379 | 2,148 231
Injured and
detained in
hospital . | 86,182 | 40,738 | 37,822 | 7,622 _ 4459 | 4,072 387
——.
Total - | 146,777 | 67,661 | 63,221 | 15,358 537 | 6,838 | 6,220 618

pai Civil Defence General Services, National Fire Service, Regular and Auxiliary
‘lice.

ANNEXURE 839

25. There were 146,777 civilian casualties in the United Kingdom
due to enemy action. Of these 60,595 were killed or missing believed
killed and 86,182 were injured and detained in hospital. These figures
include 6,838 casualties suffered by Civil Defence workers while on duty
of whom 6,220 were men and 618 women.

Merchant Navy and Fishing Fleet

26. The Merchant Navy and Fishing Fleet sustained 45,329 casualties
during the war. Of these 30,248 were fatal (including deaths presumed
in missing ships and deaths while interned), and 4,707 were wounded.
There were 4,654 men reported missing of whom 530 had not been
accounted for on February 28, 1946; in addition 5,720 men were
reported as internees. The figure for deaths, missing, and internees,
include all British subjects and nationals of allied countries who served
in British registered ships and fishing boats as well as British subjects
who served in foreign ships chartered by the United Kingdom during
the war.

Home Guard

27. Members of the Home Guard suffered 1,763 casualties attributable
to service. Of these 1,206 died of wounds, injury or illness attributed to
service and 557 were wounded (excluding accidental injuries or illness).

biatizes ty GOOgle

INDEX

ADMISSIONS TO HOSPITALS AND MEDICAL UNITS, SERVICE AND CIVILIAN
(See Casualties, Injuries and Specific Diseases)
ALIMENTARY SYSTEM, DISEASES OF, (See Digestive System, Diseases of)
APPENDICITIS, (See Digestive System, Diseases of )
AREOLAR TISSUE, DISEASES OF, (See Skin, Diseases of )
ASTHMA
Royal Navy
Total Force
incidence in, 19, 24, 29, 34, 39, 44, 49
invalidings, 19, 24, 29, 34, 39, 44, 49, 62, 73
comparison rates, men and women, 79
deaths in, 29, 34, 39, 44, 49
W.R.N.S. invalidings, 79
Army
admissions to hospitals
United Kingdom, Male Troops, 123, 124
discharges on medical grounds, Male Troops, 440
Royal Air Force, incidence in
Total Force, 478, 530
Home Force, 494
Forces Abroad, 509
W.AA-F., 611
Emergency Medical Services
Service Patients, admissions to E.M.S. Hospitals, 670

AUXILIARY TERRITORIAL SERVICE (See Women’s Auxiliary Services)

BLACKWATER FEVER ((<ce also Malaria)
Army

admissions to hospitals
West Africa, European Troops, 317, 318
United Kingdom, Male Troops, 128
East Africa, All Troops, 324

deaths in hospital
East Africa, 324
West Africa, 320, 321

medical evacuations to the United Kingdom
West Africa, European Troops, 319

BLOOD, BLOOD FORMING ORGANS, DISEASES OF,

avy
Total Force, incidence in, invalidings and deaths, 19, 24, 29, 34, 39, 44, 49
Haslar, R.N. Hospital, admissions to, in First and Second World Wars, 86
Army
admissions to hospitals
B.E.F. France, 1939-40, 180
North-West Europe, 211, 226
United Kingdom
Male Troops, 148, 150, 152, 154, 169
Female Troops, 159, 161, 163, 165
comparison rates, Male and Female troops, 166
deaths in hospital, United Kingdom
Male Troops, 157, Female Troops, 168
discharges on medical grounds
Male Troops, 449, A.T.S., 453
medical evacuations to the United Kingdom, 181, 183
Air Force, incidence in
Total Force, 477, 529
deaths in, 598, 599
final invalidings, 596
Home Force, 493
Forces Abroad, 509

841

842 INDEX

W.A.A.F., 610, 621
deaths in, 633
final invalidings, 632
Emergency Medical Services, Civilian Patients, admissions to E.M.S. Hospitals,
by sex and age group, 814-819

BRONCHITIS (See Respiratory System, Diseases of )

BURNS
Royal Navy
Total Force
burns and scalds
deaths, 31, 41, 46, 51
incidence of, 21, 26, 31, 36, 41, 46, 51
invalidings, 26, 31, 36, 41, 46, 51
multiple burns and scalds
deaths, 21, 26, 31, 36, 41, 46, 51
incidence, 21, 26, 31, 36, 41, 46, 51
invalidings, 31, 36, 41, 46, 51
Haslar, R.N. Hospital, admissions and comparison between First and Second
World Wars, 88
Army
admissions to hospitals
East Africa Command, British Troops, 326
B.E.F. France, 1939-40, 180
North-West Europe, 213, 214, 215, 228, 229
South-East Asia
Indo-Burma Front, 376, 396, 397
Ceylon, 414, 433, 434
United Kingdom
Male Troops, 135, 136, 137, 138, 155, 156
Female Troops, 147, 166, 167
admissions to medical units
British North African and Central Mediterranean Force, 247, 250, 253, 256,
259
discharges on medical grounds, 444
Male Troops, 450, 451
Royal Air Force
Total Force
by anatomical site, 483-488, 550
characteristic distribution of, in aircrew, 550, 551
developments in treatment of, 551
in combination with maxillo-facial injuries, 552
incidence, deaths and final invalidings during peak injury year, 1944, 555-561
aircrew, 562, 563
final invalidings, 597
deaths, 600
Home Force, by anatomical site, 499-505, 550
Force Abroad, by anatomical site, 515-520, 550
W.A.A.F., by anatomical site, 615, 619
Emergency Medical Services
Service Patients
admissions to E.M.S. Hospitals, by sex and age group, 725, 727, 729, 731, 733,
735, 737, 739, 741, 778
and site, 779
and cause, 780, 795, 796, 798
Civilian Patients
admissions to E.M.S. Hospitals
by cause, 811, 812, 813
by sex and age group, 820, 821

CARDIO-VASCULAR SYSTEM, DISEASES OF, (See Circulatory System, Diseases of)

CASUALTIES, general survey of, in Armed Forces, Auxiliary Services and Civilian
Population of the United Kingdom, 1939-1945, 834-839, numbers and classes of men
and women covered by survey, 829-834, categories of, distinguished in survey, 834-835

Total, killed, missing, wounded, p.o.w. or internee, 835

INDEX 843

Armed Forces, 836-838
in War against Germany, 837
in war against Japan, 837
Royal Navy, 837
Army, 837
Royal Air Force, 837
Women’s Auxiliary Services, 838
Women’s Royal Naval Service, 838
Auxiliary Territorial Service and Army Nursing Services, 838
Women’s Auxiliary Air Force, 838
Civil Defence, 838
Civilians, United Kingdom, 838
Home Guard, 839
Merchant Navy and Fishing Fleet, 839
Royal Navy
morbidity, invaliding and mortality rates for diseases and injuries (excluding
casualties in action) for 1936, 1939-1945, 1953, 14
number of cases of disease and injury, invalidings, deaths, days sickness on board
and in hospital, average number of sick daily, Total Force, 14-51
analysis of invalidings and deaths due to disease, 1934-1944, R.N., 52-79, W.R.N.S.
1941-1944, 77-79
R.N. Hospital, Haslar, admissions to and comparison between First and Second
World Wars, 80-88
Wounds and injuries, deaths, in action, 21, 26, 31, 36, 41, 45, 51, 81, 83, 88
Army
admissions to hospitals
British Expeditionary Force, France 1939-40, 172-180
injuries, E.A. and N.E.A., 175, 180, 182, 184
East Africa, 322-327
injuries, E.A. and N.E.A., 323, 326
India, 329-348
average constantly sick, British Troops, 337, Women’s Services, 348
comparison between First & Second World Wars, 341
factors influencing upward trend of morbidity rates, 328, 329
injuries E.A. and N.E.A., 334, 338
Women’s Services, 332, 348
Middle East Force, 274-299
by commands, 277, 278, 293-299
by ethnic groups, 276-277, 282-289
factors influencing steady decline in morbidity rates, 274-275
injuries, E.A. and N.E.A., 275, 276, 278, 281, 283-286, 288-292, 294, 295,
297, 299
Women’s Services, 291
North-West Europe, 188-215, 226-230
injuries, E.A. and N.E.A., 212-215, 227, 228, 229, 230
South-East Asia, Malaria Forward Treatment Units, formation of to reduce
wastage and aid general hospitals, 350
Indo-Burma Front, 352-400
injuries E.A. & N.E.A., 368, 376-378, 384-389, 391-397
by cause, 396, 397
ethnic groups, comparison between, 379-383, 399, 400
Women’s Services, 358, 367, 386, 391, 396
Ceylon, 400-437
injuries E.A. and N.E.A., 414, 415, 420-432, 433, 434
ethnic groups, comparison between, 416-419, 435-437
Women’s Services, 407, 426, 433
West Africa, 315-321
United Kingdom
Male Troops, 109-139, 148-158, 169
injuries, E.A. and N.E.A., 135-138, 148-153, 155, 156, 158
Women’s Services, 139-147, 159-168
injuries, E.A. and N.E.A., 146, 147, 160, 162, 164, 166, 167
admissions to medical units
British North African and Central Mediterranean Forces, 234-272
by ethnic group, 235, 236, 247-272

INDEX

injuries, E.A. and N.E.A., 238, 241, 244, 247, 250, 253, 256, 259, 262, 265,
267, 269, 271
North-West Europe, 215-225, 231
deaths in hospital
East Africa, 323, 324
injuries, E.A. ‘and N.E.A., 323
India Command, 330, 331, 332, 335, 337, 339, 340, 341, 342
injuries, E.A. and NE. A. 335, 339
Women’s Services, 332, 348
Middle East Force, 278, 300-314
by Commands, 311-314
by ethnic groups, 301-307
injuries, E.A. and N.E.A., 300-314
Women’s Services, 309
South-East Asia
Indo-Burma Front, 378, 379, 398
injuries, E.A. and N.E.A., 379, 398
W.A.C. (I.) and I.M.NS., 398
Ceylon, 415, 416, 435
West Africa, 320, 321
United Kingdom
Male Troops, 138-139, 157-158
injuries, E.A. and N.E.A., 139, 158
Women’s Services, 147, 168
injuries, E.A. and N.E.A., 168
discharges on medical grounds, 438-453
Male Troops, 439-446
injuries, E.A. and N.E.A., 443-446, 448, 450, 451
A.T.S., 446, 452, 453
injuries, E.A. and N.E.A., 452, 453
invalidings
India Command, I.O.Rs., 332, 339, 340, 341
injuries, 339
Women's Services, 332, 333, 348
comparison of causes of, B.O.Rs. and I.O.Rs., 243
West Africa, African Troops, 319, 320
investigation into degree of disablement and recovery rate of wounded in North-
West Europe, 106, 444-446, 447
medical evacuations to the United Kingdom (British Troops)
B.E.F., France 1939-40, 173-175, 181-184
injuries, E.A. and N.E.A., 175, 182, 184
India Command, 330, 331, 336, 337, 340, 341
injuries, E.A. and N.E.A., 336
Women’s Services, 332, 333, 348
West Africa, 319, 320
Air Force
Sickness in, 1939-1945, 465-472, definition of, 465, living conditions in relation
to, 465, 466, sickness under 48 hours duration, 466, 468, 469, 470, 471, sickness
over 48 hours duration, 466-471, number of sick daily, 467, 468, average num-
ber of days sickness per head, 468, 469, 470, 471, invalidings to the United
Kingdom, 468, 469, 470, 471, final invalidings, 468, 469, 470, 471, by cause,
rege deaths, 468, 469, 470, 471, by cause, 598-600, by geographical area,
470, 471
Total Force, 466, 468, 474-489, 521-539, 549-600, 605, 606
disease, incidence of, 473-482, 521-539
injuries, incidence of
by anatomical site, 483-488, 549
by cause, 566-568
common non-fatal injuries, 550-555
fatal injuries, 549, 550
analysis of injuries for peak year 1944, 555-561
aircrew, 562, 563
deaths, 555-564
fatality rates, head, 564, 565
diseases and injuries
by age groups, 572-586

INDEX 845

by trade groups, 587-589
comparison between air and ground personnel, 590-594
missing, presumed dead, 483, 600
Home Force, 467, 469, 472, 490-505
disease, incidence of 490-499
injuries, incidence of, 499-505
invalidings, incidence of, 469
deaths, incidence of, 469
missing, presumed dead, 499
total sickness, under 48 hours duration, over 48 hours duration, average dura-
tion of sickness per head, number of sick daily, 467, 469, 472
Forces Abroad, 467, 469, 472, 506-520
by geographical areas, 470, 471
disease, incidence of, 506-514, 540-548
injuries, incidence of, 515-520
invalidings to U.K. 469, 470, 471
invalidings, final, 469, 470, 471
deaths, 469, 470, 471
missing, presumed dead, 515
total sickness, under 48 hours duration, over 48 hours duration, average dura-
tion of sickness per head, number of sick daily, 467, 469, 470, 471, 472
Women’s Auxiliary Air Force, 601-603
Sickness in 1939-45, 601-606, sickness under 48 hours duration, sickness over
48 hours duration, number of sick daily, average number of days sickness per
heady ie 603, 605, final invalidings, 604, 606, 630, 632, 633, deaths, 604,
6, 63:
disease, incidence of, 607-615, 620-622, 630, 631
injuries, incidence of, 615-619, 621
missing, presumed dead, 615
disease and injury, by age group, 623-629
Emnareency. Medical Services, classes of patients treated in E.M.S. Hospitals,
Service Patients, admissions to E.M.S. Hospitals, 647-799
diseases by sex and age group, 647-739
duration of in-patient treatment for certain diseases, 658-660, 661-662, 666, 667,
674-678, 684, 685, 694, 696, 702, 708, 716, 717
injuries by sex and age group, 725, 727, 729, 731, 733, 735, 737, 739, 740-787
by cause, 793-795, 797-799
by cause and site, 796, 798
duration of in-patient treatment, 744-746, 756, 758-760, 764-766, 780
follow-up of fracture cases, 768-777
homologous serum jaundice following administration of blood, plasma or
serum, 787-793
Civilian Patients, admissions to E.M.S. Hospitals, 800-821
diseases, by sex and age group, 800-804, 814-819
injuries, by sex and age group, 804-813, 820, 821
by cause, 805-810
by site, 810-813
CEREBRO-SPINAL FEVER
Army
admissions to hospitals
B.E.F. France, 1939-40, 173, 176, 177, 178
East Africa, All Troops, 323, 326
West Africa, West African Troops, 316
admissions to medical units
North-West Europe, 215, 225, 231
deaths in hospital
East Africa, 323
Royal Air Force, incidence in
Total Force, 522, 524, 537, 538
W.A.A.F., 622

CIRCULATORY SYSTEM, DISEASES OF,
Royal Navy
Total Force
incidence in, 15, 19, 23, 24, 29, 33, 34, 39, 43, +1, 49

846

INDEX

deaths in, 24, 29, 34, 44, 75, 76, 77

invalidings in, 15, 24, 29, 34, 39, 44, 49, 55, 62, 63, 69, 73, 78, 79
Haslar, R.N. Hospital, admissions to, and comparison between First and Second

World Wars, 81, 86
W.R.N.S., invalidings, 78, 79

admissions to hospitals
B.E.F. France, 1939-40, 180

East Africa Command, All Troops, 323, British Troops, 326

India Command, British Officers and O.Rs., 334
Middle East Force
All Troops, 280
Ethnic Groups, 282, 284, 285, 286, 287, 289
Other British Troops, 290
Women’s Services, 291
All Other Troops, 292
by Commands, 293, 295, 296, 297, 298
North-West Europe, 207, 208, 226
South-East Asia
Indo-Burma Front
British Officers, 358, 384
British O.Rs., 358, 385
-A.I.M.N.S., 386
British Troops, 387
V.C.Os. and I.O.Rs., 388, 390
N.Cs. (E.), 363, 366, 389, 390
W.A.C. (I.) and I.MLN.S., 367, 391
All Indian Troops, 392
West African O.Rs., 371, 393
East African O.Rs., 372, 394
All Troops, 395
Ceylon
British Officers 420
British O.Rs., 421
All British Troops, 422
Indian Officers, 423
V.C.Os. and I.0.Rs., 424
N.Cs, (E.), 425
All Indian Troops, 409, 427
East African Troops, 410, 428
Ceylonese Officers, 429
Ceylonese O.Rs., 412, 430
All Ceylonese Troops, 431
All Troops, 432
United Kingdom
Male Troops, 126, 148, 150, 152, 154, 166, 169
Female Troops, 146, 159, 161, 163, 165, 166
deaths in hospital
East Africa Command, 323
India Command, B.O.Rs., 335, I.0.Rs., 339
comparison between B.O.Rs. and I.0.Rs., 342
Middle East Force
All Troops, 300
Ethnic Groups, 301, 302, 303, 304, 305, 306, 307
Other British Troops, 308
Women’s Services, 309
All Other Troops, 310
By Commands, 311-314
United Kingdom, Male Troops, 157, Female Troops,
discharges on medical grounds
Whole Army Male Troops, 442, 448, 449
ATS., 452, 453
ethnic groups, comparative rates, South East Asia
Indo-Burma Front
B.O.Rs. and V.C.Os. and I.0.Rs. 399
All O.Rs., 400

168

INDEX 847

Ceylon
British and Indian O.Rs., 417, 435
British, Indian, Ceylonese O.Rs., 436
British, Indian, Ceylonese, E. African O.Rs., 419, 437
invalidings, India Command, I.O.Rs., 339
comparison with B.O.Rs., 343
medical evacuations to the United Kingdom
B.E.F. France, 1939-40, 183, 184
India Command, B.O.Rs., 336, comparison with I.O.Rs., 343
Royal Air Force, incidence in
Total Force, ih = 1, Hees
by age group, 578, 585,
by trade groups, 588, 590, 593
deaths in, 598, 599
final invalidings in, 596
Home Force, 493
Forces Abroad, 509
W.A.A.F., 610, 621, 631
by age group, 623, 626
erat in, 653 7
invalidings, 6:
cy Medical
Service Patients, admissions to E.M.S. Hospitals, 678, 679, 680
by sex and age group, 678, 679, 724, 726, 728, 730, 732, 734, 736, 738
Civilian Patients, admissions to E.M.S. Hospitals, 802, 814-819
by sex and age group, 814-819

CIVIL DEFENCE SERVICES
composition of, 830, entitled to treatment in E.M.S. Hospitals, 800, strengths, 830,
831, 833
casualties, admissions to E.M.S. Hospitals
diseases, 800-804, 814-819
injuries, 804-813, 820, 821, 838
killed, missing believed killed, 838
COMMON COLD
Royal Navy
Total Force
incidence in, 15, 17, 22, 27, 32, 37, 42, 47
R.N. Hospital Haslar, admissions to, and comparison between First and Second
World Wars, 81, 85

admissions to hospitals
B.E.F. France, 1939-40, 179
East Africa Command, British Troops, 325
India Command, British Troops, 332, 334, Indian Troops, 332, 338
North-West Europe, 211, 226
South-East Asia
Indo-Burma Front
British Officers, 357, 384
British O.Rs. 357, 385
Q.A.1.M.N.S., 386
All British Troops, 387
V.C.Os. and I.0.Rs., 362, 365, 388, 390
N.Cs, (E.), 363, 365, 389, 390
W.A.G. (I.) and ILM.N.S., 391
All Indian Troops, 392
West African O.Rs., 371, 393
East African O.Rs., 372, 394
All Troops, 375, 395
Ceylon
British Officers, 401, 420
British O.Rs., 403, 421
All British Troops, 422
V.C.Os. and I.0.Rs., 405, 424
I.M.N.S., 426
N.Cs. (E.), 407, 425

848 INDEX

All Indian Troops, 408, 427
East African O.Rs., 410, 428
Ceylonese Officers, 411, 429
Ceylonese O.Rs., 411, 430
All Ceylonese Troops, 412, 431
All Troops, 414, 432
United Kingdom
Male Troops, 128, 148, 150, 152, 154, 169
Female Troops, 145, 146, 159, 161, 163, 165
comparison, Male and Female Troops, 145, 166
ethnic groups, comparative rates
South-East Asia
Indo-Burma Front
B.O.Rs. and V.C.Os. and I.0.Rs., 380, 382, 399
All O.Rs., 400
Ceylon
B.O.Rs. and V.C.Os. and I.O.Rs., 417, 435
B.O.Rs. and V.C.Os. and I.O.Rs. and Ceylonese O.Rs., 418, 436
Loto and V.C.Os. and I.0.Rs. and Ceylonese and E. African O.Rs.,
ethnic groups, susceptibility to
South-East Asia
Indo-Burma Front, Indian Troops, 383
Ceylon, Ceylonese, Indian Troops, 419
Air Force, incidence in
Total Force, 475, 522
aircrew forbidden to fly with, 587
Home Force, 491
Forces Abroad, 507
W.A.A.F., 608
Medical Services
Service Patients
admissions to E.M.S. Hespirals, 656-660, 725, 727, 729, 731, 733, 735, 737, 739
by sex and age group, 656
days in-patient treatment, 659, 660
DEATHS, (See Casualties, Injuries and Specific Diseases.)
DEFICIENCY DISEASES, (See Nutrition, Metabolism, Disorders of)
DENGUE FEVER
Royal Navy, incidence in Total Force, 17, 22, 27, 32, 37, 42, 47

Gdoniscions to hospitals
India Command, high incidence in British Officers, 329, 334, B.O.Rs., 334
South-East Asia
Indo-Burma Front
British Officers, 354, 384
British O.Rs., 357, 385
Q.A.L.M.N.S., 359, 386
All British Troops, 387
V.C.Os. and I.0.Rs., 362, 388, 390
N.Cs. (E.), 363, 389, 390
W.AC. (L) & LM.N.S., 367, 391
All Indian Troops, 392
West African O.Rs., 393
East African O.Rs., 394
All Troops, 375, 395
Ceylon
British Officers, 401, 420
British O.Rs., 402, 421
All British Troops, 404, 422
Indian Officers, 423
V.C.Os. and I.0.Rs., 405, 424
N.Cs. (E.), 407, 425
I.M.N.S., 426
All Indian Troops, 409, 427
East African O.Rs., 410, 428

INDEX 849

Ceylonese Officers, 429

Ceylonese O.Rs., 430

All Ceylonese Troops, 431

All Troops, 414, 432

ethnic groups, comparative rates, South East Asia

Indo-Burma Front

B.O.Rs. and V.C.Os. and I.0.Rs., 399

All O.Rs., 400

lon

B.O.Rs., V.C.Os. and I.O.Rs. 416, 417, 435

B.O.Rs., Ceylonese O.Rs., V.C.Os. and I.0.Rs., 436

B.O.Rs., Ceylonese, East African and Indian O.Rs., 437
ethnic groups, relative susceptibility to

Indo-Burma Front, B.O.Rs., 380, 382, 383

Ceylon, B.O.Rs., 418, 419

DIARRHOEA
Army
admissions to hospitals

B.E.F. France, 1939-40, 173, 176, 177, 178

East Africa Command, 323, 326

India Command, British Officers, 333, 334, 347, British O.Rs., 333, 334, 347
Indian Officers, 331, 338, 347, Indian O.Rs., 331, 338, 347

South-East Asia

Indo-Burma Front
British Officers, 353, 384
British O.Rs., 356, 385
Q.A.I.M.N.S., 358, 359, 386
All British Troops., 387
V.C.Os. and I.0.Rs., 362, 388, 390
N.Cs. F), 363, 365, 389, 390
W.A.C. (I.) & I.M.N.S., 367, 391
All Indian Troops, 369, 392
West African O.Rs., 371, 393
East African O.Rs., 372, 395
All Troops, 374, 376, 395
Ceylon
British Officers, 401, 420
British O.Rs., 402, 421
All British Troops, 404, 422
Indian Officers, 423
V.C.Os. and I.O.Rs., 405, 424
N.Cs. (E.). 406, 425
I.M.N.S., 426
All Indian Troops, 408, 409, 427
East African O.Rs., 428
Ceylonese Officers, 411, 429
Ccylonese O.Rs., 412, 430
All Ceylonese Troops, 431
All Troops, 414, 432
ethnic groups, comparison of incidence
India Command, British & Indian Officers, British & Indian O.Rs., 330, 332, 347
South-East Asia
Indo-Burma Front
B.O.Rs. and V.C.Os. and 1.0.Rs., 380, 382, 399
O.Rs. All Groups, 383, 400
Ceylon
B.O.Rs. and V.C.Os. and I.O.Rs., 435
B.O.Rs. and V.C.Os. and I.O.Rs., and Ceylonese O.Rs., 418, 436
B.O.Rs. and V.C.Os. and I.0.Rs., and Ceylonese O.Rs., and E. African
O.Rs., 437
high incidence, reasons for, India Command, 329
Emergency Medical Services
Service Patients, admissions to E.M.S. Hospitals, 722, 723

DIGESTIVE SYSTEM, DISEASES OF,
Royal Navy

850 INDEX

Total Force
incidence in, 15, 16, 19, 20, 24, 25, 29, 30, 34, 35, 39, 40, 44, 45, 49, 50
deaths due to, 19, 20, 24, 25, 29, 34, 39, 44, 49, 75, 76, 77
invalidings, 16, 19, 20, 24, 25, 29, 34, 39, 44, 49, 54, 63, 71, 73, 78, 79
comparison rates, men and women R.N., 79
appendicitis
incidence, 15, 20, 25, 29, 34, 40, 44, 49
invalidings, 20, 25, 29, 34, 40, 44, 49
deaths, 20, 25, 29, 34, 40, 44, 49
hernias
incidence, 15, 19, 24, 29, 34, 39, 44, 49
invalidings, 19, 24, 29, 34, 39, 44, 49
deaths, 19, 24, 39, 44, 49
liver, diseases of
incidence, 15, 20, 25, 30, 35, 40, 45, 50, 87
invalidings, 20, 24, 25, 30, 35, 40, 45, 50
deaths, 20, 24, 25, 30, 35, 40, 45, 50
peptic ulcers
incidence, 16, 19, 20, 24, 25, 29, 34, 39, 44, 49, 54,
invalidings, 16, 19, 20, 24, 25, 29, 34, 39, 44, 49,
deaths, 19, 20, 24, 25, 29, 34, 39, 44, 49
stomach and duodenum
incidence, 15, 20, 25, 29, 34, 40, 44, 49, 8
invalidings, 20, 24, 25, 29, 34, 40, 44,
deaths, 20, 24, 25, 29, 34, 40, 44, 49
W.R.N.S., invalidings, 78, 79
Haslar, R.N. Hospital
admissions to, 81, 82
appendicitis, 81, 87, hernias, 81, 86
comparison between First and Second World Wars, 81
Army
admissions to hospitals
B.E.F. France, 1939-40, 173, 176, 177, 178, 180
East Africa Command
All Troops, 323, British, 323
appendicitis, 326, hernias, 326
peptic ulcers, 326
India Command
British Officers, 334, B.O.Rs., 334
Middle East Force
All Troops, 279, 280
Ethnic Groups, 282, 284, 285, 286, 288, 289
Other British Troops, 290
Women’s Services, 291
All Other Troops, 292
By Commands, 294, 295, 297, 299
North-West Europe, 188-190, 226
appendicitis, 189, hernias, 189, 190
peptic ulcers, 189, 190, 230
South-East Asia Command
Indo-Burma Front
British Officers, 353, 384
British O.Rs., 356, 385
Q.A.LM.N.S., 359, 386
All British Troops, 387
V.C.Os. and I.0.Rs., 362, 365, 388, 390
N.Cs. (E.), 363, 365, 389, 390
W.A.C. (I.) & ILM.N.S., 367, 391
All Indian Troops, 392
West African O.Rs., 371, 393
East African O.Rs., 372, 394
All Troops, 375, 395
Ceylon
British Officers, 401, 420
British O.Rs. 402, 421
All British Troops, 422

6, 78, 79, B1, 82, 87
63, 71, 73, 78, 79

aes

a

INDEX

Indian Officers, 423
-C.Os. and I.O.Rs., 405, 424
425

Ceylonese Officers, 411, 429
Ceylonese O.Rs., 411, 430
All Ceylonese Troops, 431
All T: } 414, 432
United Kingdom
Male Troops, 111-113, 148, 149, 152, 154, 166, 169
appendicitis, 111, 112, 142
dyspepsia & gastritis, 111, 112, 142
haemorrhoids, 112, 142
hernias, 111, 112, 142
ulcers
duodenal, 112, 142, 169
gastric, 112, 142, 169
peptic, 112, 142
Female Troops, 141, 142, 160, 162, 164, 165, 166
appendicitis, 141, 142 ie
lyspepsia and gastritis, 141, 14:
haemorrhoids, 141, 142
hernias, 141, 142
ulcers
duodenal, 141, 142
gastric, 141, 142
peptic, 141, 142
comparison, Male and Female Troops, 142, 166
admissions to medical units
British North African and Central Mediterranean Force
All Troops, 238, 241, 244
African, 259, 271
British, 247, 262
Canadian, 250, 265
Indian, 256, 269
New Zealand, 253, 267
deaths in hospital
East Africa Command, 323
India Command
B.O.Rs., 335, I.0.Rs., 339
comparison between B.O.Rs. and I.O.Rs., 342
Middle East Force
All Troops, 300
Ethnic Groups, 301, 302, 303, 304, 305, 306, 307
Other British Troops, 308
Women’s Services, 309
All Other Troops, 310
By Commands, 311-314
United Kingdom
Male Troops. 139, 158
Female Troops, 168
discharges on medical grounds
Male Troops, 440, 447, 448, 449
A.T.S., 446, 452, 453
ethnic groups comparison between
India B.O.Rs. and V.C.Os. and I.O.Rs., 380, 382, 399
All O.Rs. 383, 400
South-East Asia
Indo-Burma Front, British Officers and O.Rs., 356
Ceylon, B.O.Rs., V.C.Os. and I.O.Rs., 435
B.O.Rs., Ceylonese, V.C.Os. and I.0.Rs., 436
B.O.Rs., Ceylonese, East African, V.C.Os. and I.0.Rs., 437
ethnic groups, relative susceptibility, South-East Asia, 419
medical evacuations to the United Kingdom

28cms

851

852 INDEX

B.E.F. France, 1939-40, 174, 182, 184
India Command, B.O.Rs., 336
Air Force, incidence in
Total Force, 476, 521, 527, 585, 590
peptic ulcers, 476, 585
limitation of flying duties, due to, 528
average duration of treatment, 528
average number of sick daily, 528
appendicitis, 476, 585
hernias, 476, 585
by age groups, 577, 585
peptic ulcers, 577, 585
by trade groups, 588, 590, 593
peptic ulcers, 588, 590, 592, 593
Home Force, 492
Peptic ulcers, 492
appendicitis, 492
hernias, 492
Forces Abroad, 508
Peptic ulcers, 508
appendicitis, 508
hernias, 508
W.A.A.F., 609, 620, 621, 631
peptic ulcers, 609, 620
appendicitis, 609, 620
by age groups, 626
deaths, R.A.F., 528, 599
peptic ulcers, 528, 599
appendicitis, 599
W.A.AF., 633
final invalidings, R.A.F., peptic ulcers, 528, 595, 596
W.A.A.F., 632
Emergency Medical Services
Service Patients
acluniesions to E.M.S. Hospitals, 707, 709, 724, 726, 728, 730, 732, 734, 736,

Hs dicitis, 705, 706, 707, 724, 726, 728, 730, 732, 734, 736, 738
y sex and age group, 706, 707
casestatality rate, 70
duration of treatment, 707, 708
dyspepsia, functional, 670, 671, 672, 724, 726, 728, 730, 732, 734, 736, 738
duration of treatment, 677
gastro-enteritis, 705, 706, 707, 724, 726, 728, 730, 732, 734, 736, 738
by sex and age 706
hernias, 700-703, 55, 924, 73 726, 728, 730, 732, 734, 736, 738
by sex and age groups, 700, 701
duration of treatment, 702, 703
sprue, 707, 710
lee, gastric and duodenal, 703-705, 707, 724, 726, 728, 730, 732, 734, 736
38

by sex and age groups, 703, 704
with oration or haemorrhage, 704, 705
case-fatality rates, 705
Civilian Patients
admissions to E.M.S. Hospitals, 802-804, 814-819
by sex and age group, 814-819

incidence in, 17, 22, Pi 32, 37, 42, 47
invalidings, 32, 37, 4
deaths, 17, "22, "27, 32, 37, 42, 47
RN. Hospital, Haslar, admissions to, in First & Second World Wars, 85
Army
admissions to hospitals

INDEX 853

B.E.F. France, 1939-40, 176, 177, 178, 179
Middle East Force
All Troops, 275, 280
Ethnic Groups, 282, 284, 285, 286, 287, 289
Other British Troops, 290
All Other Troops, 292
Women’s Services, 291
By Commands, 293, 295, 296, 298, high incidence in certain commands, 277
North-West Europe, 209-211
South-East Asia
Indo-Burma Front
British Officers, 354, 384
British O.Rs., 358, 385
Q.A.LMLN.S., 386
All British Troops, 387
V.C.Os. and I.0.Rs., 388, 390
N.Cs. (E.), 367, 389, 390
All Indian Troops, 392
All Troops, 375, 395
Ceylon
British Officers, 401, 420
British O.Rs., 421
All British Troops, 422
V.C.Os. and 1.0.Rs., 406, 424
N.Cs. (E.), 407, 425
All Indian Troops, 427
East African O.Rs., 410, 428
Ceylonese O.Rs., 430
All Ceylonese Troops, 431
All Troops, 432
United Kingsom
Male Troops, 134, 148, 150, 152, 154, 169
Female Troops, 146, 159, 161, 163, 165
admissions to medical units
British North African and Central Mediterranean Force
All Troops, 237, 241, 244
African, 235, 259, 271
British, 247, 262
Canadian, 250, 265
Indian, 235, 256, 269
New Zealand, 253, 267
peak incidence, 234
deaths in hospital
Middle East Force
All Troops, 300
Ethnic Groups, 301, 302, 303, 304, 305, 306, 307
Other British Troops, 308
All Other Troops, 310
Women’s Services, 309
By Commands, 311-314
United Kingdom
Male Troops, 157
Female Troops, 168
discharges on medical grounds
Male Troops, 449
ethnic groups, comparative rates
South-East Asia
Indo-Burma Front
B.O.Rs. and V.C.Os. and I.0.Rs., 380, 382, 399, 400
Ceylon
B.O.Rs., V.C.Os. and I.O.Rs., 416, 417, 435
British, Indian, Ceylonese O.Rs., 418, 436
British, Indian, Ceylonese and E. African O.Rs., 418, 437
ethnic groups, relative susceptibility to
Middle East Force, 276, 277
South-East Asia, Ceylon, 419

28*cms

854 INDEX

medical evacuations to the United Kingdom
B.E.F. France, 1939-40, 181, 183
Air Force, incidence in
Total Force, 522, 524
W.A.A.F., 622
Emergency Medical Services
Service Patients
admissions to E.M.S. Hospitals,{663
DISEASE and INJURIES (See Casualties, Injuries and under Specific Diseases)

DYSENTERY
Royal Navy
‘otal Force
incidence in, 17, 22, 27, 32, 37, 42, 47
deaths, 17, 22, 32, 37, 42, 47
invalidings, 27, 32, 37, 42, 47
R.N. Hospital, Haslar, admissions to, 81, 82, 85
Army
admissions to hospitals
B.E.F. France, 1939-40, 176, 177, 178, 179
East Africa Command
All Troops, 323, 324, 327
British Troops, 325
India Command
British Officers, 330, 333, 334
British Other Ranks, 330, 333, 334
Indian Officers, 331, 338
Indian Other Ranks, 331, 338
Middle East Force
All Troops, 275, 279, 280
by Ethnic Groups, 282, 284, 285, 286, 287, 289
Other British Troops, 290
All Other Troops, 292
Women’s Services, 291
By Commands, 293, 295, 296, 298
North-West Europe, 211, 226
South-East Asia Command
Indo-Burma Front
British Officers, 353, 384
British O.Rs., 355, 385
-A.I.M.N.S., 358, 359, 386
British Troops, 387
V.C.Os. and 1.0.Rs., 361, 388, 390
N.Cs. &), 363, 364, 365, 389, 390
W.A.C. (I.) and I.M.N.S., 367, 391
All Indian Troops, 369, 392
West African O.Rs., 371, 393
East African O.Rs., 371, 394
All Troops, 374, 376, 395
Ceylon
British Officers, 401, 420
British O.Rs., 402, 421
All British Troops, 404, 422
Indian Officers, 423
V.C.Os. and 1.0.Rs., 405, 424
N.Cs. (E.)., 406, 425
I.M.N.S., 426
All Indian Troops, 408, 409, 427
East African O.Rs., 410, 428
Ceylonese Officers, 429
Ceylonese O.Rs., 412, 430
All Ceylonese Troops, 431
All Troops, 432
West Africa
Europeans, 316, 317
West Africans, 316

INDEX 855

United Kingdom
Male Troops, 135, 148, 150, 152, 154, 169
Female Troops, 159, 161, 163, 165
admissions to medical units
B.N.A. and C.M.F., 234, 235, 236
Peak incidence, 234
Al T: , 237, 239, 241, 242, 244
African, 259, 260, 271, 272
British, 247, 248, 262, 263
Canadian, 250, 251, 265, 266
Indian, 256, 257, 269, 270
New Zealand, 253, 254, 267, 268
North-West Europe, 218, 219, 231
deaths in hospital
East Africa Command, 323, 324
India Command
B.O.Rs., 330, 335
L.O.Rs., 339
comparison between B.O.Rs. & I.O.Rs., 342
Middle East Force
All Troops, 300
Ethnic Groups, 301, 302, 303, 304, 305, 306, 307
Other British T: , 308
All Other Troops, 310
Women’s Services, 309
By Commands, 311-314
West Africa, Europeans & Africans, 321
United Kingdom, Male Troops, 157
discharges on medical grounds, Male Troops, 449
ethnic groups, comparative rates in
South-East Asia
Indo-Burma Front
B.O.Rs. and V.C.Os. and I.0.Rs., 380, 382, 399
All Other Ranks, 383, 400
Ceylon
B.O.Rs. and V.C.Os. and I.O.Rs., 417, 435
B.O.Rs., V.C.Os. and I.0.Rs. and Ceylonese O.Rs., 418, 436
B.O.Rs., V.C.Os. and I.O.Rs., Ceylonese and East African O.Rs., 437
ethnic groups, relative si tibility to
Middle East Force, 276, 277
South-East Asia, Ceylon, 419
high incidence, reasons for in
ndia Command, 329, 330
Middle East Force, Egypt Command, 277
invalidings, West Africa, West African Troops, 319
medical evacuations to the United Kingdom
B.E.F. France, 1939-40, 181, 183
India Command, B.O.Rs., 336
West Africa, 319
Royal Air Force, incidence in
Total Force, 474, 521, 540, 541
by age groups, 575, 576, 584
chemotherapy, 540, 541
comparison with Crimean and South African Wars, 540
heavy incidence in India and A.C.S.E.A., 541
Home Force, 490, 540, 541
Forces Abroad, 506, 540
India and A.C.S.E.A., 540, 541, 545
Traq, 540, 547
Middle East, 540, 541, 546
West Africa, 540, 548
W.A.A.F., 608

Emergency Medical Services
Service Patients, admissions to E.M.S. Hospitals, 662, 663

856 INDEX

EAR, NOSE and THROAT, DISEASES OF,
Royal Na’

vy
Total Force
incidence in, 15, 19, 23, 29, 33, 39, 43, 49
invalidings due to, 19, 23, 29, 33, 39, 43, 49, 62, 68, 73, 79
deaths, 23, 33, 43, 49
Haslar, R.N. Hospital, admissions in First and Second World Wars, 86
Army
admissions to hospitals
B.E.F. France, 1939-40, 174, 180
East Africa Command
All Troops, 323, British 325
India Command, British Troops, 334
Middle East Force
All Troops, 280
Ethnic Groups, 282, 284, 285, 286, 288, 289
Other British Troops, 290
Women’s Services, 291
All Other Troops, 292
By Commands, 294, 295, 297, 299
North-West Europe, 190-191, 226, 230
South-East Asia Command
Indo-Burma Front
British Officers, 353, 384
B.O.Rs., 357, 385
-A.LM.N.S., 359, 386
British T: , 387
V.C.Os. and 1.0.Rs., 388, 390
N.Gs. (E). 363, 366, 389, 390
W.A.C. (I.) and I.M.N.S., 367, 391
All Indian Troops, 392
West African O.Rs., 393
East African O.Rs., 372, 394

Ceylon
British Officers, 420
British O.Rs., 421
All British Troops, 422
Indian Officers, 423
V.C.Os. & 1.0.Rs., 405, 424
N.Cs. (E.), 425
LMLN\S., 426
All Indian Troops, 427
East African O.Rs., 410, 428
Ceylonese Officers, 411, 429
Ceylonese O.Rs., 430
All Ceylonese Troops, 431
All Troops, 432
United Kingdom
Male Troops, 115, 116, 148, 150, 152, 154, 169
Female Troops, 140, 141, 159, 161, 163, 165
comparative rates, Male & Female, 166
deaths in hospital
East Africa, 323
Middle East Force, All Troops, 300
Ethnic Groups, 301, 302, 303, 304, 305, 306, 307
Other British Troops, 308
All Other Troops, 310
By Commands, 311-314
United Kingdom
Male Troops, 157
ae ‘emale Trocps, 1G
ischarges on medical grounds
Male Troops, 443, 448, 449
A.T.S., 452, 453
ethnic groups, comparative rates

INDEX 857

South East Asia Command
Indo-Burma Front
B.O.Rs. and V.C.Os. and I.O.Rs., 380, 382, 399
All O.Rs., 383, 400

Ceylon
British and Indian O.Rs., 416, 435
British, Ceylonese and Indian O.Rs., 436
ren British, Ceylonese, E. African & Indian O.Rs., 419, 437
Invi dings
Indian Command, I.O.Rs., 339
comparative rates, B.O.Rs., I.O.Rs., 343
West Africa, 319
medical evacuations to the United Kingdom
B.E.F, France 1939-40, 174, 181, 183
India Command, B.O.Rs., 336, comparison with I.0.Rs., 343
West Africa, 319
Royal Air Force, incidence in
Total Force, 480, 521, 533
EAR diseases, incidence of, 480, 533
otitis media, 480, 533
otitis externa, 480, 533, 594
otitic barotrauma, important cause of non-effectiveness among flying per-
by sonnel, Sear ican
age groups, 581,
by trade groups, 589, 591
higher incidence among aircrew, 593
final invalidings, R.A.F., 597, W.A.A.F., 632
Home Force, 497
diseases, incidence of 497
otitis media, 497
otitis externa, 497
Forces Abroad.
EAR diseases, incidence of, 512
otitis media, 512
otitis externa, 512, 533
W.A.A.F., 613, 620, 621, 631
by age group, 624, 629
icy Medical Services
Service Patients
admissions to E.M.S. Hospitals
throat, 656, 666, 668, 669
ear diseases, 674, 678, 724, 726, 728, 730, 732, 734, 736, 738

ENDOCRINE SYSTEM, DISEASES OF,
Royal Na

wy
Total Force
incidence, invalidings and deaths in, 19, 24, 29, 34, 39, 44, 49
Haslar, R.N. Hospital, comparison between First and Second World Wars,

Army
admissions to hospitals
B.E.F., 180
North-West Europe, 226
United Kingdom, Male Troops, 148, 150, 152, 154, 169
Female Troops, 159, 161, 163, 165
deaths in hospital, United Kingdom, Male Troops, 157
discharges on medical grounds
Male Troops, 449, A.T.S., 452, 453
medical evacuations to the United Kingdom, B.E.F., 182, 184
Royal Air Force, incidence in
Total Force, 481, 521
final invalidings, 597
Home Force, 498
Forces Abroad, 513
W.AA.F., 614
final invalidings, 632

858 INDEX

Emergency Medical Services
Service Fatents; admissions to E.M.S. Hospitals, 668, 724, 726, 728, 730, 732, 734,
36,
ENTERIC GROUP OF FEVERS
Royal Navy
Total Force

incidence in, and deaths in, 17, 22, 27, 32, 37, 42, 47
invalidings, 27, 37, 47

admissions to hospitals
B.E.F. France, 1939-40, 176, 177, 178, 179
East Africa Command
All Troops, 323, 327, British Troops, 325
India Command
British Troops, 334
Indian Troops, 338
Middle East Forces
All Troops, 280
Ethnic Groups, 282, 284, 285, 286, 287, 289
Other British Troops, 290
Women’s Services, 291
All Other Troops, 292
By Commands, 293, 295, 296, 298
North-West Europe, 226
South-East Asia
Indo-Burma Front
British Officers, 358, 384
British O.Rs., 358, 385
Q.A.LM.NS., 386
All British Troops, 387
V.C.Os. and LORs., 388, 390
N.Cs. (E.), 363, 367, 389, 390
All Indian Troops, 392
West African O.Rs., 393
East African O.Rs., 394
All Troops, 375, 395
Ceylon
British Officers, 420
British O.Rs., 421
All British Troops, 422
V.C.Os. and I.0.Rs., 406, 424
N.Cs. (E.), 407, 425
W.A.C. (I.) and I.M.N.S., 391
All Indian Troops, 427
East African, 42
Ceylonese O.Rs., 412, 430
All Ceylonese Troops, 431
All Troops, 432
United Kingdom
Male Troops, 148, 150, 152, 154, 169
Female Troops, 159, 161, 163, 165
admissions to medical units
British North African and Central Mediterranean Force
All Troops, 237, 239, 241, 242, 244, 245
African, 259, 260, 271
British, 247, 248, 262, 263
Canadian, 250, 251
Indian, 256, 257, 269
New Zealand, 253, 254, 267
North-West Europe, 224, 225, 231
deaths in hospitals
East Africa Command, 323
India Command
B.O.Rs., 334, I.0.Rs., 339
comparison B.O.Rs. & 1.O.Rs., 342

INDEX

Middle East Force
All Troops, 300
Ethnic Groups, 301, 302, 303, 304, 305, 306, 307
Other British Troops, 308
Women’s Services, 309
All Other Troops, 310
By Commands, 311-314
United Kingdom, Male Troops, 157
ethnic groups, comparative rates
South-East Asia
Indo-Burma Front
B.O.Rs. & V.C.Os. & I.0.Rs., 380, 382, 399
All O.Rs., 400
Ceylon
British & Indian O.Rs., 416, 417, 435
British, Ceylonese and Indian O.Rs., 436
British, Ceylonese, E. African & Indian O.Rs., 418, 437
ethnic groups, susceptibility to
South-East Asia
Indo-Burma Front, British Troops, 383
Ceylon, British Troops, 419
Royal Air Force, incidence in
Total Force, 474, 521
by age groups, 576, 584
deaths, 598, 599
Home Force, 490
Forces Abroad, 506, 521, 541
India and A.C.S.E.A., 541, 545

Iraq, 547

Middle East, 546

West Africa, 548
W.A.A.F., 608

ENTERITIS
Air Force, incidence in
Total Force, 474
by age groups, 577, 584
Home Force, 490
Forces Abroad, 506, 541
India and A.C.S.E.A., 545
Iraq, 547
Middle East, 546
West Africa, 548
W.A.A.F., 608
EYE, DISEASES OF,
Royal Nav
Total Force
incidence in, 15, 16, 19, 23, 29, 33, 39, 43, 49
invalidings due to, 16, 19, 23, 29, 33, 39, 43, 49, 62, 67, 73, 79
W.R.N.S., 79
Haslar, R.N. Hospital, admissions First and Second World Wars, 86
Army
admissions to hospitals
B.E.F. France, 1939-40, 180
rae Africa Command, All Troops, 323, British, 325
ndia
British Troops, 334
Indian Troops, 338
Middle East Force
All Troops, 280
Ethnic Groups, 283, 284, 285, 286, 288, 289
Other British Troops, 290
Women’s Services, 291
All Other Troops, 292
By Commands, 294, 295, 297, 299

859

860 INDEX

North-West Europe, 226
South-East Asia
Indo-Burma Front
British Officers, 384
British O.Rs., 358, 385
Q.A.I.M.N.S., 386
All British Troops, 387
V.C.Os. and I.0.Rs., 388, 390
N.Cs. (E.), 363, 366, 389, 390
W.A.G. (I.) and I.M.N.S., 368, 391
All Indian Troops, 392
‘West African O.Rs., 371, 393
East African O.Rs., 372, 394
All Troops, 375, 395
Ceylon
British Officers, 401, 420
British O.Rs., 403, 421
All British Troops, 422
V.C.Os. and 1.0.Rs., 405, 424
N.Cs. (E.), 407, 425
LM.N.S., 426
All Indian Troops, 408, 427
East African O.Rs., 410, 428
Ceylonese Officers, 429
Ceylonese O.Rs., 412, 430
All Ceylonese Troops, 430
All Troops, 432
United Kingdom
Male Troops, 133, 134, 148, 150, 152, 154, 169
Female Troops, 159, 161, 163, 165
deaths in hospital, United Kingdom, Male Troops, 157
discharges on medical grounds
Male Troops, 443, 448, 449
AT.S., 452, 453
ethnic groups, comparative rates
South-East Asia
Indo-Burma Front
B.O.Rs. & V.C.Os. & I.0.Rs., 380, 382, 399
All O.Rs., 400
lon
British & Indian O.Rs., 416, 417, 435
British, Indian, Ceylonese O.Rs., 417, 436
British, Indian, Ceylonese, East African O.Rs., 419, 437
ethnic groups, susceptibility to
South-East Asia
Indo-Burma Front, Indian Troops, 383
Ceylon, Indian and Ceylonese Troops, 419
invalidi:
India, Indian Troops, 339
medical evacuations to the United Kingdom
B.E.F. France, 1939-40, 174, 181, 183
Royal Air Force, incidence in
Total Force, 480, 521, 533, 581, 589, 591
by age groups, 581
by trade groups, 589, 591
final invalidings, 597
Home Force,
Forces Abroad, 511
higher incidence abroad, 533
W.A.A.F., 613, 621, 624, 628, 631
by age groups, 624, 628
final invalidings, 632
Emergency Medical Services
Service Patients, admissions to E.M.S. Hospitals, 674, 724, 726, 728, 730, 732,
734, 736, 738

INDEX 861

GENITO-URINARY SYSTEM, DISEASES OF,
Royal Navy
Total Force, incidence, 15, 20, 21, 25, 26, 30, 31, 35, 40, 41, 45, 50, 51
invalidings, 20, 21, 25, 26, 30, 31, 35, 40, 41, 45, 50, 51
deaths, 21, 25, 26, 31, 35, 41, 45, 50, 51
R.N. Hospital, Haslar, admissions to, 87
W.R.N.S. invalidings due to, 78, 79
Army
admissions to hospitals
B.E.F. France 1939-40, 180
East Africa Command, British Troops, 326
North-West Europe, 197-199, 227
United Kingdom
Male Troops, 119-121, 148, 150, 152, 154, 169
Female Troops, 140, 141, 160, 162, 164, 165
comparative rates, United Kingdom, Male & Female Troops, 166
deaths in hospital, United Kingdom
Male Troops, 158
Female Troops, 147, 168
discharges on medical grounds
Male Troops, 448, 449
A.TS., 446, 452, 453
medical evacuations to the United Kingdom
B.E.F. France, 1939-40, 174, 175, 182, 184
Royal Air Force, incidence in
Total Force, 478, 521, 530
by age groups, 579, 585
by trade groups, 588, 590, 593
Home Force, 494, 495, 530
Forces Abroad, 510, 530
Wives: 611, 615, 520, 621, 631
age groups, 624, 627
deaths, Total Force, 598, 599
W.A.A.F., 633
final invalidings, Total Force, 596
W.A.A.F., 632
Medical Services
Service Patients
admissions to E.M.S. Hospitals, 710-714, 724-739
Male, 712-714
by age group, 712
Female, 710-712, 713
by age group, 710, 712
Civilian Patients
admissions to E.M.S. Hospitals, 802, 814-819
by sex and age group, 814-819

HASLAR, ROYAL NAVAL HOSPITAL, admissions to and comparison between
First and Second World Wars, 13, 80-89

HERNIA, (Sce Digestive System, Diseases of)

HOMOLOGOUS SERUM JAUNDICE, following blood, plasma or serum adminis-
tration, 787-793
deaths due to, 793, 799
(See also Infective Hepatitis)

HEAT, EFFECTS OF,
Royal Navy
Total Force
incidence in and deaths in, 21, 26, 31, 36, 41, 46, 51
Haslar, R.N. Hospital, admissions and comparison between First and Second
World Wars, 88

y
Admissions to hospital,
India Command, high incidence, reasons for, 330
British Officers, 330, 334
British O.Rs., 330, 334, 344

862 INDEX

Indian Officers, 338
Indian O.Rs., 338
Middle East Force
All Troops, 275, 280
Ethnic Groups, 282, 284, 285, 286, 287, 289
Other British Troops, 290
All Other Troops, 292
‘Women’s Services, 291
By Commands, 293, 295, 296, 298
deaths in hospitals
‘India Command, B.O.Rs., 335, 344
Middle East Force, 300, 301, 302, 307, 310
By Commands, 311, 312, 313, 314
‘West Africa, European & African Troops, 321
ethnic groups, comparison of incidence in
India Command, B.O.Rs. and 1.O.Rs., 330, 345
ethnic groups, relative susceptibility to
Middle East Force, United Kingdom Troops, 276, 277
Royal Air Force, incidence in
Total Force, 489, 582, 589
Home Force, 505
Forces Abroad, 520
W.A.A.F., 619

INFECTIVE HEPATITIS
Royal Navy
Total Force, incidence in, 15, and diseases of the liver, 15
Haslar, R.N. Hospital, admissions to, 83, 84

Army
admissions to hospitals
B.E.F. France, 1939-40, 179
East Africa Command
All Troops, $23, 326, British Troops, 325

p
British Other Ranks, 329, 334
Middle East Force
All Troops, 275, 280
Ethnic Groups, 282, 284, 285, 286, 287, 289
Other British Troops, 290
All Other Troops, 292
Women’s Services, 291
By Commands, 293, 295, 296, 298

P<]

All British Troops, 38'
V.C.Os. and I.0.Rs., 362, 363, 366, 388, 390
N.Cs.(E.), 363, 366, 389, 390

W.A.. (L) and ILM.N.S., 367, 391

All Indian Troops, 392
‘West African O.Rs., 371, 393
East African O.Rs., 372, 394
All Troops, 374, 376, 395

British Officers, 401, 420
British O.Rs., 403, 421

All British Troops. 404, 422
Indian Officers, 423

V.C.Os. and I.0.Rs., 405, 424
N.Cs. (E.), 407, 425

All Indian Troops, 409, 427
East African O.Rs., 410, 428

INDEX 863

Ceylonese Officers, 411, 429
Ceylonese O.Rs., 412, 430
All Ceylonese Troops, 431
All Troops, 432
West Africa 4
Europeans, 316
Africans, 316
United Kingdom
Male Troops, 148, 150, 152, 154
Female Troops, 159, 161, 163, 165
admissions to medical units
British North African and Central Mediterranean Force, peak incidence, 234
All Troops, 237, 239, 241, 242, 244, 245
African, 259, 260, 271, 272
British, 247, 248, 262, 263
Canadian, 235, 250, 251, 265
Indian, 256, 257, 269, 270
New Zealand, 235, 253, 254, 267
North-West Europe, 219, 220, 231
deaths in hospital
East Africa Command, 323
Middle East Force
All Troops, 300
Ethnic Groups, 301-307
Other British Troops, 308
All Other Troops, B10
Women’s Services, 309
By Commands, 311-314
West Africa, Europeans and West Africans, 321
United Kingdom, Male Troops, 157
ethnic groups, comparative rates
South-East Asia
Indo-Burma Front
B.O.Rs. and V.C.Os. and I.0.Rs., 380, 382, 399
O.Rs. All Groups, 383, 400
Ceylon
B.O.Rs., V.C.Os. and I1.O.Rs., 417, 435
B.O.Rs., V.C.Os. and I.O.Rs. and Ceylonese O.Rs., 436
BO Mts V.C.Os. and I.O.Rs. and Ceylonese O.Rs. and E. African O.Rs.,
ethnic groups, relative susceptibility to,
Middle East Force, 276, 277
South-East Asia, Ceylon, 418, 419
Air Force, incidence in
Total Force, 522, 537, 538
by age groups, 573, 575
Forces road, 343, 544
highest incidence in Mediterranean region, India and Far East, 544
India and A.C.S.E.A., 545
Iraq, 547
Middle East, 546
West Africa, 548
W.A.A.F., 622 35698
by age groups, 623,
ergency Medical Services
Service Patients
admissions to E.M.S. Hospitals, 687, 689-700, 724, 726, 728, 730, 732, 734, 736,
3
by sex and age group, 689, 690, 691
duration of in-patient treatment, 694, 696
epidemiology of, 691, 694, 695
first symptoms of, in order of frequency, 697
complications of, 698
by rank, 699
seasonal and regional incidence, 691, 692, 693
time interval between attacks, 694, 697

29CMS

864 INDEX

following arsenical therapy, 699, 700
Homologous Serum Jaundice, 687, 690, 787-793

INFLUENZA
Royal Navy
Total Force, incidence in, 17, 22, 27, 32, 37, 42, 47
deaths, 22, 27, 42
invaliding, 32
R.N. Hospital, Haslar, admissions to, 81, 85
Army
admissions to hospitals
B.E.F. France, 1939-40, British Troops, 172, 176, 177, 178, 179
East Africa Command, All Troops, 323
North-West Europe, 211, 226
United Kingdom
Male Troops, 132, 148, 150, 152, 154, 166, 169
Female Troops, 145, 146, 159, 161, 163, 165, 166
admissions to medical units, British North African and Central Mediterranean
Force
All Troops, 237, 241, 244
African Troops, 259, 271
British Troops, 247, 262
Canadian Troops, 235, 250, 265
Indian Troops, 256, 269
New Zealand Troops, 253, 267
deaths in hospital
United Kingdom
Male Troops, 157
Female Troops, 168
medical evacuations to United Kingdom
B.E.F. France, 1939-40, 181, 183
Royal Air Force, incidence in
Total Force, 475, 522, 572
Home Force, 491
Forces Abroad, 507
India and A.C.S.E.A., 545, Middle East, 546
Iraq, 547, West Africa, 548
W.A.A.F., 607, 608
Emergency Medical Services
Service Patients
admissions to E.M.S. Hospitals, 656-660, 725, 727, 729, 731, 733, 735, 737, 739
by sex and age group, 656
days of in-patient treatment, 657, 658, 660
INJURIES, overall casualties suffered by the Armed Forces, Auxiliary Services and
Civilian Population of the United Kingdom during the war period, 834-839
definition of wounded, 835
Armed Forces, 834-838
against Germany and Italy, 837
against Japan, 837
Civil Defence, 834-836, 837
Women’s Auxiliary Services, 834-836, 838
United Kingdom Civilians, 834-836, 838, 839
Home Guard, 836, 839
Merchant Navy and Fishing Fleet, 836, 839
Royal Navy
incidence, invalidings and deaths in, 14, 15
Total Force, in action, 21, 26, 31, 36, 41, 46, 51
general and local, 21, 26, 31, 36, 41, 46, 51
R.N. Hospital, Haslar, comparison between First and Second World Wars,
general injuries, 81, 83, 88, in action, 81, 88
overall casualties, 834-838
Army
admissions to hospitals
B.E.F., 180
East Africa, E.A., 323, N.E.A., 323, 326
India, British Troops, E.A., 334, N.E.A., 334

INDEX 865

Indian Troops, 338
Middle East Force
Male Troops, E.A. and N.E.A., 275, 281, 283, 284, 285, 286, 288, 289, 290,
292
Women’s Services, E.A. and N.E.A., 291
by geographical command, All Troops, E.A. and N.E.A., 294, 295, 297, 299
North-West Europe
E.A., 106, 212-215, 227, 228, 229, 230
N.E.A., 212-215, 222, 228, 229, 230
South-East Asia
Indo-Burma Front
E.A. and N.E.A., 376-379
Male Troops, 384, 385, 387, 388, 389, 392, 393, 394, 395, 396, 397
Women’s Services, 386, 391
Ceylon, E.A. and N.E.A., 414-415
Male Troops, 420, 421; 422, 423, 424, 425, 427, 428, 429, 430, 431, 432,
4
Women’s Services, 426, 433
United Kingdom
Male Troops, E.A. and N.E.A., 110, 135-138, 149, 151, 153, 155, 156, 159
Female Troops, E.A. and A., 140, 146, 147, 160, 162, 164, 166, 167
admissions to medical units :
B.N.A. and C.M.F., E.A. and N.E.A., 238, 241, 244, 247, 250, 253, 256, 259,
262, 265, 267, 269, 271
by cause
South-East ore Indo-Burma Front, 378, 596, 397,
Ceylon, 433, 4
deaths in hospitals,
East Africa, E.A., 323, N.E.A., 323
India, British Troops, NE. A., 335, 342
Indian Troops, 339, 342
Middle East Force
All Troops, E.A., 300, 301, 302, 303, 304, 305, 306, 307, 308, 310
N.E.A., 278, 300, 301, 302, 303, 304, 305, 306, 307, 308, 310
Women’s Services, N.E.A., 309
by geographical Commands, 311-314
South-East Asia, Indo-Burma Front, 378, 379, 398
United Kingdom
Male Troops, E.A. and N.E.A., 138, ‘139, 158
Female Troops, N.E.A., 168
discharges on medical grounds
Male Troops, 443-446, 448, 450, 451
A.T.S., 446, 452
invalidings, India, Indian Troops, 339
comparison between rates for B.O.Rs. & I.0.Rs., 343
investigation into degree of disablement and recovery-rate of wounded in North-
West Europe, 106, 444—446, 44'
medical evacuations to the United ie agdees
B.E.F., E.A., 182, 184
N.E.A., 182, 184
India, British Troops, E.A., 336, N.E.A., 336
overall casualties, 834-838
Royal Air Force, incidence in
Total Force
general, 483
local, by anatomical site, 483-488, 549
Home Force
general, 499
local, by anatomical site, 500-505
Forces Abroad
general, 515, 545, 546, 547, 548
local, by anatomical site, 515-520, 545, 546, 547, 548
by age groups, 582, 583, 586
by causes, fatal and non-fatal, 566, 567, 568
by trade groups, 589
aircrew and ground personnel, 592, 594

866 INDEX

common non-fatal injuries to flying personnel, 550-555
burns, 550-551
head, 551-552
maxillo-facial, 552
spinal, vertical compression, 552, 553
forcible flexion, 552-554
other orthopaedic, 554
frostbite, 554
immersion, 555
deaths due to, 600
by anatomical site, 600
head, 551, 552, 564, 565
types of injury, 549, 550
detailed analysis of injuries for peak year, 1944, 555-561
aircrew, 562-563
eye injuries, 565
skull-fatality rates, 564
maxillo-facial, 564
final invalidings, 597
overall casualties, 834-838
W.A.A.F.
general, 615, 621, 631
local, by anatomical site, 616-619
by age groups, 629
deaths, 633 ‘
final invalidings, 632
overall casualties, 834-838
Emergency Medical Services, definition and classification of, 740-742
Service Patients, admissions to E.M.S. Hospitals, 649, 650, 651, 725, 727, 729,
731, 733, 735, 737, 739, 740-799
All Injuries, by sex and age group, 742
burns, 778-780
by anatomical site, 779
by caus, (eee #4
y sex and age group, |
fractures (other than head), 748-777
vertebral column, 749-752
spinal cord, 750-752
deaths, 751, 752
other sites (trunk), 752-753
upper limbs, 753-760
luration of treatment, 756, 758, 759
lower limbs, 760-766
duration of treatment, 764, 765, 766
multiple, 766-768
amputation rates, 769
follow up of fracture cases, 768, 770-777
head injuries, 743-747, 822, 823
duration of treatment, 744-746
other injuries, 780-787
open wounds, by site, 781
sprains and strains, 782, 783 eee
Homologous Serum Jaundice following blood, plasma or serum administration,
deaths due to, 789, 790
by cause and anatomical site, 793-799
Civilian Patients, classification of, 804
admissions, enemy action and non-enemy action, 804-813, 820, 821
Civil Defence personnel, 805, 806
Merchant Navy, 805, 806
Ordinary Civilians, 805, 806
by anatomical site, 810-813
by cause, 806-810
Overall Casualties, 834, 835, 836, 838, 839

INVALIDINGS, (See Casualties, Injuries and Specific Diseases)

INDEX 867

JAUNDICE (See Infective Hepatitis and Homologous Serum Jaundice)

KNEE JOINT, INTERNAL DERANGEMENT OF, (See Musculo-Skeletal System,
Diseases of )

LEPROSY, Army, West Africa Command, invalidings, African Troops, 319
LIVER, DISEASES OF THE, (See Digestive System, Diseases of)
MALARIA
Royal Navy
Total Force, incidence in, 15, 17, 22, 27, 32, 37, 42, 47
invalidings, 27, 32, 37, 42, 47
deaths, 22, 27, 32, 37, 42, 47

Haslar, R.N. Hospital, admissions and comparison between First and Second
World Wars, 81, 85

Army
admissions to hospitals
B.E.F. France, 1939-40, 179
East Africa Command,
All Troops, 323, 324, 327
British, 325
India Command
British Officers, 330, 333, 334
British Other Ranks, 330, 331, 333, 334
Indian Officers, 330, 331, 333, 338
Indian Other Ranks, 330, 331, 333, 338
Middle East Force
All Troops, 275, 279, 280
Ethnic Groups, 282, 284, 285, 286, 287, 289
Other British Troops, 290
All Other Troops, 292
Women’s Services, 291
By Commands, 293, 295, 296, 298
North-West Europe, 211, 226
South-East Asia,
Indo-Burma Front
British Officers, 353, 355, 384
British O.Rs., 355, 385
Q.A.LMLN.S., 358, 359, 386
All British Troops, 387
V.C.Os. and I.0.Rs., 361, 388, 390
N.Cs. (E.), 363, 364, 389, 390
W.A.C. (I.) and I.M.N.S., 367, 391
All Indian Troops, 369, 392
West African O.Rs., 370, 393
East African O.Rs., 372, 394
All Troops, 373, 374, 376, 379, 395
Ceylon
British Officers, 401, 420
B.O.Rs., 402, 411, 421
All British Troops, 403, 422
Indian Officers, 423
V.C.Os. and I.O.Rs., 405, 424
N.Cs. (E.), 406, 425
1.M.N.S., 426
All Indian Troops, 408, 409, 427
East Africa, 410, 428
Ceylonese Officers, 411, 429
Ceylonese O.Rs., 411, 430
All Ceylonese Troops, 413, 431
All Troops, 432
West Africa
Europeans, 315, 316, 318, 320
West Africans, 315, 316, 320
United Kingdom
Male Troops, 127, 128, 148, 150, 152, 154, 169
Female Troops, 159, 161, 163, 165

868 INDEX

admissions to medical units
British North African and Central Mediterranean Force, 232, 234, 235, 236,
237, 239, 241, 242, 245, 247, 248, 250, 253, 254, 256, 257, 259, 260, 262, 263,
265, 266, 267, 268, 269, 270, 271, 272
primary oe relapse, 235, 239, 242, 245, 248, 251, 254, 257, 260, 263, 268,
70, 27:
ethnic variations, 235, 236
seasonal variations, 234
All Troops, 237, 239, 241, 242, 244, 245
African Troops, 259, 260, 271, 272
British Troops, 247, 248, 262, 263
Canadian Troops, 250, 251, 265, 266
Indian Troops, 236, 256, 257, 269, 270
New Zealand Troops, 236, 253, 254, 267, 268
North-West Europe, 220-222, 231
deaths in hospital
East Africa, 323, 324
India, B.O.Rs., 330, 335, I.0.Rs., 339
comparison between B.O.Rs. and I.0.Rs., 342
Middle East Force
All Troops, 300
Ethnic Groups, 301-307
Other British Troops, 308
All Other Troops, 310
Women’s Services, 309
By Commands, 311-314
West Africa, Europeans and West Africans, 320, 321
United Kingdom, Male Troops, 157
discharges on medical grounds
Male Troops, 449, A.T.S., 453
ethnic groups, comparative rates
India, B.O.Rs. and 1.0.Rs., 346
South-East Asia
Indo-Burma Front
B.O.Rs. and V.C.Os. and I.0.Rs., 380, 381, 382, 399
All O.Rs., 370, 383, 400
Ceylon
B.O.Rs. and V.C.O.s and I.O.Rs., 417, 435
B.O.Rs., Ceylonese, V.C.Os. and 1.0.Rs., 418, 436
B.O.Rs., East African, Ceylonese and Indian O.Rs., 437
West Africa, Europeans and West Africans, 317
ethnic groups, relative susceptibility to,
Middle East Force, 276, 277
South-East Asia, 419
West Africa, 315
high incidence, reasons for
India, 329
Middle East Force, Sudan and Eritrea, 277
invalidings, India, 1.0.Rs., 339
malaria forward treatment units in South-East Asia, 350
medical evacuations to the United Kingdom
B.E.F. France, 1939-40, 181, 183
India, B.O.Rs., 336
West Africa, Europeans, 319
Royal Air Force, incidence in
Total Force, 474, 521
by age groups, 576, highest incidence 20-24 age group, 584
deaths, 599
Home Force, 490
Forces Abroad, 506, 542, 543
India and A.C.S.E.A., 542, 543, 545
Traq, 543, 547
Middle East, 542, 543, 546
West Africa, 542, 543, 548
importance of malaria discipline, 542

INDEX 869

mepacrine therapy, 543
WAAF., 608

cy Medical Services
Service Patients, admissions to E.M.S. Hospitals, 662, 663, 664

MEASLES
Royal Navy
Total Force
incidence in, 17, 22, 27, 32, 37, 42, 47
deaths, 17
Haslar, R.N. Hospital, admissions to, 81, 85
Army
admissions to hospitals
B.E.F. France, 1939-40, 173, 176, 177, 178, 179
United Kingdom
Male Troops, 135, 148, 150, 152, 154, 169
Female Troops, 159, 161, 163, 165
comparative rates, male and female troops, U. K., 168
deaths in hospital, U.K. male troops, 1)
Royal Air Force
Total Force, incidence in, 522, 537, 538
W.A.A.F,, incidence in, 607, 622
Emergency Medical Services
Service Patients, admissions to E.M.S. Hospitals, 663

MEDICAL STATISTICS, Sources of data and preparation of, difficulties concerning,
xiii, documentation Service patients admitted to E.M.S. Hospitals, difficulties concer-
ning, 101, 107, 109, 462

Royal Navy, 5-13
invalidings, 52-54, 59, 60
Haslar, R.N. Hospital, 80
Committees on Naval Medical Statistics, report of, 89-90
Army, 100-106, lack of standard medical statistical return, 102
Service patients in E.M.S. Hospitals, 100, 101, 107-109
B.N.A. and C.M.F., 232-234
East Africa, 322
France, B.E.F., 170-172
India, 328
M.E.F., 273-274
North West Europe, 185-188, 215-216
S.E.A.C., 349-351
West Africa, 315
United Kingdom, 107-109
discharges on medical grounds, 438
Royal Air Force, 461-464
problems of classification, 462, 463
Emergency Medical Services, 641-646, 822-824
problems of classification, 822, 823

MENTAL DISEASES, (See Nervous System and Mental Diseases)

MERCHANT NAVY and FISHING FLEET, strengths, 830, 831
casualties, killed, missing and wounded, prisoner-of-war, 836, 839
treated in E.M.S. hospitals, 805, 806

METABOLISM, DISEASES OF, (See Nutrition and Metabolism, Disorders of)

MOUTH, TEETH and GUMS, DISEASES OF,
Royal Navy
Total Force
incidence in, 19, 24, 29, 34, 39, 44, 49
invalidings, 24, 39, 4
Haslar, R.N. Hospital, admissions in First and Second World Wars, 86
Army
admissions to hospitals
B.E.F. France, 1939-40, 180
East Africa, British Troops, 326
North-West Europe, 202-204, 226

870 INDEX

United Kingdom
Male Troops, 131, 132, 148, 150, 152, 154, 166, 169
Female Troops, 159, 161, 163, 165, 166
deaths in hospitals, United Kingdom, Male Troops, 157
invalidings, India, Indian Troops, 339
medical evacuations to the United Kingdom, B.E.F. France, 1939-40, 182, 184
Air Force, incidence in
Total Force, dental conditions, 476, Vincent’s angina, 475
Home Force, dental conditions, 492, Vincent’s angina, 491
Forces Abroad, dental conditions, 508, Vincent’s angina, 507
W.A.A.F., dental conditions, 609, Vincent’s angina, 608
Emergency Medical Services
Service Patients, admissions to E.M.S. hospitals, 724, 726, 728, 730, 732, 734, 736,
7
Vincent’s angina, 662, 663

Royal Navy
Total Force, incidence in, 17, 22, 27, 32, 37, 42, 47
Haslar, R.N. Hospital, admissions in First and Second World Wars, 85
Army
admissions to hospitals
B.E.F. France, 1939-40, 179
India, Indian Officers and O.Rs., 338
high incidence in Gurkha recruits, 331
Middle East Force
All Troops, 280
British Troops, 282
New Zealand Troops, 284, 286
South African Troops, 284, 285
Indian Troops, 287
Other British Troops, 290
Women’s Services, 291
All Other Troops, 292
All Troops, by Commands, 293, 295, 296, 298
North-West Europe, 211, 226
South-East Asia
Indo-Burma Front
British Troops, 354, 358, 384, 385, 386, 387
Indian Troops, 362, 363, 366, 388, 389, 390, 392
W.A.O.Rs., 371, 393
E.A.O.Rs., 372, 394
All Troops, 375, 395
é womens Services, Q.A.I.M.N.S., 386, W.A.C. (I.), 391
eylon
British Troops, 403, 420, 421, 422
Indian Troops, 424, 425, 427
East African Troops, 410, 428
Ceylonese Troops, 412, 429, 430, 431
All Troops, 432
United Kingdom
Male Troops, 146, 148, 150, 152, 154
Female Troops, 146, 159, 161, 163, 165, 169
comparison, Male and Female Troops, 146, 166
admissions to medical units, North-West Europe, 223, 224, 231
ethnic groups, relative susceptibility to,
India Command, high incidence among Gurkha recruits, 331
Middle East Force, fndian and native troops, 276, 277
South-East Asia
Indo-Burma Front
comparison B.O.Rs. and V.C.Os. and I.O.Rs., 380, 382, 390
O.Rs., All Groups, 382, 383, 400
Ceylon
comparison, B.O.Rs., V.C.Os. and I.0.Rs., 416, 417, 435
comparison, O.Rs., All Groups, 418, 419, 437
comparison, B.O.Rs., Ceylonese and Indian O.Rs., 436

INDEX 871

medical evacuations to the United Kingdom, B.E.F., 1939-40, 181, 183
Royal Air Force, incidence in

Total Force, 522, 537

W.A.A.F., 607, 622
Emergency Medical Services

Service Patients, admissions to E.M.S. hospitals, 663

MUSCULO-SKELETAL SYSTEM, DISEASES OF,
Royal Navy .
Total Force
incidence in, and deaths in, 20, 21, 25, 30, 35, 40, 41, 45, 50
invalidings, 20, 21, 25, 30, 35, 40, 41, 45, 50, 63, 72, 73, 78
arthritis, 63, 72, 73, 79
comparison rates, men and women R.N., 79
W.R.N.S., invalidings, 78, 79
Haslar, R.N. Hospital, admissions First and Second World Wars, 81, 87

admissions to hospitals
B.E.F. France, 1939-40, 180
East Africa Command, All Troops, 323, British Troops, 323
North-West Europe, 195-197, 227
knee joint, internal derangement of, 195, 196
United Kingdom
Male Troops, 116-118, 148, 150, 152, 154, 169
knee joint, internal derangement of, 116, 117
Female Troops, 142, 143, 160, 162, 164, 165
comparison, male and female troops, 166
deaths in hospitals
East Africa Command, 323
United Kingdom, Male Troops, 158, Female Troops, 168
discharges on medical grounds
Male Troops, 441, 448, 449
A.T.S., 452, 453
medical evacuations to the United Kingdom
B.E.F. France, 1939-40, 174, 182, 184
Air Force, incidence in
Total Force, 479, 521, 531
articular rheumatism, 531
knee joint, internal derangement of, 531
by age group, 579, 585, 586
by trade group, 588, 591, 593
final invalidings, 595, 596
Home Force, 495
Forces Abroad, 511
W.A.A.F., 612, 620, 621, 631
knee joint, internal derangement of, 612, 620
by age group, 624, 627
final invalidings, 632
Emergency Medical Services
Service Patients
admissions to E.M.S. Hospitals, 664-668, 716, 719-721, 726, 728, 730, 732, 734,
736, 738
by sex and age group, 719
congenital malformations, 721
foot strain, 720
knee joint, internal derangement of, 719
prolapsed intervertebral disc, association with sciatica, 673, 674
rheumatic group, 664-668, 724, 726, 728, 730, 732, 734, 736, 738
by sex and age group, 665
duration of in-patient treatment, 667
stress or fatigue fracture, 720, 721
Civilian Patients
admissions to E.M.S. Hospitals, 802, 803, 814-819
by sex and age group, 814-819

NAVAL MEDICAL STATISTICS COMMITTEES, Work of, 9-12, 89
29*CMS

872 INDEX

NERVOUS SYSTEM and MENTAL DISEASES
Royal Navy
Total Force
incidence, 18, 23, 28, 33, 38,
epilepsy, 18, 23, 28, 33, 38
mental diseases, 18, 23, 28.
deaths, 18, 23, 28, 33, 38, 43, 48, 4:
invalidings, 15, 16, 18, 23, 2 , 33,
comparison rates, men and women
epilepsy, 18, 23, 28, 33, 38, 43, 49, 73
mental diseases, 18, 23; 28, 33, 38, 49, 56, 65, 73
psychoses and neuroses, 15, 16, 54, 62, 65, 73
W.R.N.S. invalidings, 78, 79
comparison rates men and women R.N. 79
epilepsy, 78, 79
mental diseases, 78, 79
psychoses, neuroses etc. 78, 79
Haslar, R.N. Hospital, admissions to and comparison between First and Second
World Wars, 81, 82, 86

43, 48, 49, 81, 86

'y
admissions to hospitals
B.E.F. France, 1939-40, 180
East Africa Command, All Troops, 323, British Troops, 325
India Command
British Officers, 334 _—British O.Rs., 334
Indian » » 338 Indian ,, , 338
Middle East Force
All Troops, 275, 280
Ethnic Groups, 282, 284, 285, 286, 287, 289
Other British Troops, 290
All Other Troops, 292
Women’s Services, 291
By Commands, 293, 295, 296, 298
North-West Europe, 199-201, 206-207, 226, 230
South-East Asia
Indo-Burma Front
British Officers, 354, 358, 384
British O.Rs., 357, 358, 385
Q.A.I.M.N.S., 359, 386
All British Troops, 360, 387
V.C.O.s and I.0.Rs., 362, 388, 390
N.Cs.(E.), 363, 366, 389, 390
W.A.C.(I.) and I.M.N.S., 368, 391
All Indian Troops, 392
West African O.Rs., 371, 393
East African Trooy , 372, 394
All Troops, 374, 3 6, 395
Ceylon
British Officers, 402, 420
British O.Rs., 421
All British Troops, 404, 422
Indian Officers, 423
V.C.Os. and 1.0.Rs., 406, 424
N.Cs.(E.), 407, 425
All Indian Troops, 409, 427
East African O.Rs., 410, 428
Ceylonese Officers, 429
Ceylonese O.Rs., 412, 430
Ceylonese All Troops, 431
All Troops, 414, 432
United Kingdom
Male Troops, 121-123, 128-130, 148, 150, 152, 154, 169
psychoneuroses, 121, 122
psychoses, nae
epilepsy, |
Female Troops, 144, 159, 161, 163, 165

INDEX 873

psychoneuroses, 144
psychoses, 144 ‘
comparison of rates, male and female troops, 166
admissions to medical units
British North African and Central Mediterranean Force, 235
psychiatric disorders, high incidence in African Troops, 236
All Troops, 238, 241, 244
African, 236, 259, 271
British, 247, 262
Canadian, 236, 250, 265
Indian, 236, 256, 269
New Zealand, 253, 267
deaths in hospital
East Africa Command, 323
India Command, B.O.Rs., 335, I.0.Rs., 339
comparison B.O.Rs., I.0.Rs., 342
Middle East Force
All Troops, 300
Ethnic Groups, 301, 302, 303, 304, 305, 306, 307
Other British Troops, 308
All Other Troops, 310
Women’s Services, 309
By Commands, 311-314
United Kingdom
Male Troops, 139, 157
Female Troops, 168
discharges on medical grounds
Male Troops, mental disorders, 439, 446, 448, 449
nervous system, 441, 442, 448, 449
A.T.S., mental disorders, 446, 452, 453
nervous system, 452, 453
ethnic groups, comparison of incidence in
South-East Asia
Indo-Burma Front
British Officers and B.O.Rs., 358
V.C.Os. and I.O.Rs and N.Cs.(E.), 366
B.O.Rs. and V.C.Os. and I.O.Rs., 380, 382, 399
All Other Ranks, 400
Ceylon
British and Indian O.Rs., 417, 435
British, Ceylonese, and Indian O.Rs., 418, 436
British, Ceylonese, East African and Indian O.Rs., 418, 419, 437
ethnic groups, relative susceptibility to :
Middle East Force, 276, 277
South East Asia, B.O.Rs., 380, 383, 419
invaliding
India Command, 332, 339, comparison B.O.Rs., I.O.Rs., 343
West Africa, 319
medical evacuations to the United Kingdom
B.E.F. France, 1939-40, 174, 181, 183
India Command, B.O.Rs., 331, 336, comparison B.O.Rs., I.O.Rs., 343
West Africa, European Troops, 319
Royal Air Force, incidence in
Total Force, 479, 521, 531, 532, 579, 580, 581, 586, 589, 590, 591, 593, 595, 596
psychoneuroses, 479
causes of, 532, 579, 586, 589, 591, 593, 595, 596
psychoses, 479, 532, 580, 586, 589, 591, 593, 596
epilepsies, 479, 580, 586, 589, 591, 593, 596
airsickness, psychological aspects of, 532, 533
by age groups, 579, 580, 581, 586
psychoncuroses, increased incidence with age, 86
by trade groups, 589, 591, 593
“flying stress’, 532, high incidence in G.D. Officers in Bomber Command, 593
Home Force, 495, 496
Forces Abroad, 511
W.A.A.F., 612, 620, 621, 631

874 INDEX

by age group, 624, 627, 628
psychoneuroses, 612, 620, 627, 630, 631
more prevalent among officers, 630
deaths, Total Force, 599, W.A.A.F., 633
final invalidings
Total Force, 595, 596
psychoneuroses, most important cause of, 595, 596
W.A.A.F., responsible for over half the total of, 630, 632, 633
psychoneuroses, much higher than in R.A.F., 630, 632
Emergency Medical Services
Service Patients
admissions to E.M.S. Hospitals, 724, 726, 728, 730, 732, 734, 736, 738
battle exhaustion, 783, 987
psychoneuroses
by sex and age group, 670, 671, 672, 674, 675
psychoses, 672
sciatica, 673, 674
association with prolapsed intervertebral disc, 673
by sex-age group, 674, 675
Civilian Patients
admissions to E.M.S. Hospitals, 802-804, 814-819
by sex and age group, 814-819

NURSING SERVICES, (See Women’s Auxiliary Services)

NUTRITION and METABOLISM, DISORDERS OF,
Royal Navy
Total Force
incidence, invalidings, average number of sick daily, 20, 25, 30, 35, 40, 45, 30
deaths, 30, 35, 40, 45, 50
Haslar, R.N. Hospital
admissions to and comparison between First and Second World Wars, 87

admissions to hospitals
B.E.F. France, 1939-40, 180
East Africa, All Troops, 323
North-West Europe, 227
South-East Asia
Indo-Burma Front
British Troops, 382, 384, 385, 386, 387
Indian Troops, 367, 382, 388, 389, 390, 391, 392
All Troops, 375, 395
West African Troops, 393
East African Troops, 394
measures taken to improve standards of nutrition in Indian Army, $75
Ceylon
British Troops, 402, 420, 421, 422
Indian Troops, 406, 423, 424, 425, 426, 427
East African Troops, 428
Ceylonese Troops, 429, 430, 431
All Troops, 432
West Africa, vitamin deficiencies, 321
United Kingdom, 135
Male Troops, 148, 150, 152, 154, 158, 169
Female Troops, 160, 162, 164, 165
deaths in hospital, East Africa, 323
discharges on medical grounds, Male Troops, 449, AT.S., 453
ethnic groups
comparison of rates, South-East Asia
Indo-Burma Front
B.O.Rs. and I.0.Rs., 399
British, Indian, East African, West African O.Rs., 400
Ceylon
British and Indian Troops, 435
British, Indian and Ceylonese O.Rs., 436
British, Indian, East African, Ceylonese O.Rs., 437
relative susceptibility to .

INDEX 875

Ceylon
British and Indian O.Rs., 418
Indian and Ceylonese O.Rs., 419
medical evacuations to the United Kingdom
B.E.F. France, 1939-40, 182, 184
Royal Air Force, incidence in
‘otal Force, 481, 521
final invalidings, 597
Home Force, 498
Forces Abroad, 513
W.AA-F., 614
final invalidings, 632

PNEUMONIA
Royal Navy
Total Force, incidence, invalidings and deaths in, 17, 22, 27, 32, 37, 42
Haslar, R.N. Hospital, admissions to in First and Second World Wars, 81, 85

Army
admissions to hospitals
B.E.F. France, 1939-40, 176, 177, 178, 179
East Africa Command
All Troops, 323, 325
British Troops, 325
comparison First and Second World Wars, All Troops, 327
India Command
British Troops, 334
Indian Troops, 338
South-East Asia
Indo-Burma Front
British Officers, 354, 384
British O.Rs., 385
Q.A.1.MLN.S., 386
All British Troops, 387
V.C.Os. and I.0.Rs., 362, 367, 388, 390
N.Cs.(E.), 363, 367, 389, 390
W.A.C.(I.) and I.M.N.S., 367, 368, 391
All Indian T: 392

British Officers, 420
All British Troops, 422
V.C.Os. and I.O.Rs., 424
N.Cs.(E.), 425
All Indian Troops, 427
East African O.Rs., 428
Ceylonese O.Rs., 431
All Ceylonese Troops, 431
All Troops, 432
West Africa Command, 316
United Kingdom
Male Troops, 130, 131, 148, 150, 152, 154, 169
Female Troops, 146, 159, 161, 163, 165
comparison, Male and Female Troops, 166
North-West Europe, 208, 209, 226
admissions to medical units
British North African and Central Mediterranean Force,
All Troops, 237, 241, 244
British Troops, 247, 262
Canadian Troops, 250, 265
New Zealand Troops, 253, 267
Indian Troops, 256. 269
African Troops,, 259, 271
North-West Europe, 222, 223, 231
deaths in hospital

876 INDEX

East Africa Command, All Troops, 323
India Command, 332
B.O.Rs., 335
1.0.Rs., 339
comparison, B.O.Rs. and I.O.Rs., 342
West Africa, 320, 321
United Kingdom
Male Troops, 138, 157
Female Troops, 147, 168
discharges on medical grounds
Male Troops, 449, A.T.S., 453
ethnic groups, relative susceptibility
South-East Asia,
Indo-Burma Front
B.O.Rs. and V.C.Os. and I.0.Rs., 380, 382, 399
All Groups, O.Rs. 382, 383, 400
West African, African Troops, 315, 316
medical evacuations to the United Kingdom
B.E.F., 175, 181, 183
Air Force, incidence in
Total Force, 475, 521, 522
by age group, 572, 574,
highest incidence in under 20’s, 572
consistently higher incidence in aircrew than in ground personnel, 587
in various trade groups, 588, 590
deaths, 599
Home Force, 491
high incidence 1944, 522
deaths, 522
Forces Abroad, 507
Emergency Medical Services
Service Patients
admissions to E.M.S. hospitals, 679, 681, 682, 684, 686, 687, 725, 727, 729,
731, 733, 735, 737, 739
duration of treatment, 688

POISONINGS, FOOD, TOXIC SUBSTANCES AND INDUSTRIAL HAZARDS
Royal Navy
Total Force
incidence in, 21, 26, 31, 36, 41, 46, 51
deaths, 26, 31, 36, 41, 46, 51
invalidings, 26, 31, 36, 41, 46, 51
Haslar, R.N. Hospital, comparison, admissions First and Second World Wars, 87
Army
admissions to hospitals
B.E.F., France, 1939-40, 180
North-West Europe, 227
United Kingdom
Male Troops, 149, 151, 153, 154
Female Troops, 160, 162, 164, 165
admissions to medical units
B.N.A. and C.M.F., food poisoning, 237, 241, 244, 247, 250, 256, 259, 262, 269,
271
deaths in hospital
United Kingdom, Male Troops, 158
medical evacuations to the United Kingdom
B.E.F. France, 1939-40, 182, 184
Royal Air Force, incidence in
Total Force, 481, 482, 483
Home Force, 498, 499
Forces Abroad, 513, 514, 515
W.A.A.F. 614, 615
cy Medical Services
Service Patients
admissions to E.M.S. Hospitals, 725, 727, 729, 731, 733, 735, 737, 739, 777, 778

INDEX 877

Civilian Patients
admissions to E.M.S. Hospitals, 811, 812, 814, 815, 816, 817, 818, 819, 820, 821
PRISONERS-OF-WAR, total numbers, 835, 836
Armed Forces, Royal Navy, Army, Royal Air Force, 836
in war against Germany and Italy, 837, 838
in war against Japan, 837, 838
Women’s Auxiliary Services, 836, 838
Merchant Navy and Fishing Fleet, 836, 839
PYREXIA OF UNCERTAIN ORIGIN
Royal Navy
Total Force, number of cases, invalidings, deaths, days sickness on board and in
hospital, average number of sick daily, 17, 22, 27, 32, 37, 42, 47
R.N. Hospital Haslar, admissions to, comparison between First and Second World
Wars, 85
Army
admissions to hospitals
B.E.F. France, 1939-40, 179
East Africa, British Troops, 325
India, British Troops, 334
Middle East Force, 280, 282, 284, 285, 286, 287, 289, 290, 292,
by Commands, 293, 295, 296, 298,
Women’s Services, 291
North-West Europe, 226
South-East Asia
Indo-Burma Front, 353, 361, 364, 368, 369, 370, 372, 373, 374, 380, 381, 382,
383, 384-390, 392-395, 399, 400
Women’s Services, 391
Ceylon, 401, 402, 405, 406, 410, 411, 417, 419, 420, 421, 422, 423, 425, 426,
427, 428, 429, 430, 431, 432, 435, 436, 437
United Kingdom
Male Troops, 148, 150, 152, 154, 169
Female Troops, 159, 161, 163, 165
deaths in hospital
M.E.F. 300-308, 310
by Commands, 311-314
Women’s Services, 309
United Kingdom, Male Troops, 157
medical evacuations to the United Kingdom, B.E.F., 181, 183
Air Force, incidence in,
Total Force, 474
Home Force, 490
Forces Abroad, 506, 545, 546, 547, 548
W.A.A.F., 608
RESPIRATORY SYSTEM, DISEASES OF,
Royal Navy
Total Force
incidence in, 19, 24, 29, 34, 39, 44, 49
bronchitis, 15, 19, 24, 29, 34, 39, 44, 49, 62, 70, 73, 79
invalidings, 19, 24, 29, 34, 39, 44, 49, 62, 70, 73
comparison between men and women R.N., 79
deaths, 19, 24, 29, 34, 39, 44, 49, 75, 76, 77
W.R.N.S., invalidings, 78, 79
Haslar, R.N. Hospital, admissions to in First and Second World Wars, 86, bron-
chitis, 81, 86
Army
admissions to hospitals
B.E.F. France, 1939-40, 172, 176, 177, 178, 180
East Africa Command, All Troops, 323, British Troops, 326
India Command
British Officers, 334, British O.Rs., 334
Indian Officers, 333, 338, Indian O.Rs., 333, 338
Middle East Force
high incidence due to imprecise diagnosis, 275
varying incidence in certain commands, bronchitis, 278
All Troops, 279, 280

878

INDEX

Ethnic Groups, 282, 284, 285, 286, 287, 289
Other British Troops, 290
Women’s Services, 291
All Other Troops, 292
By Commands, 294, 295, 297, 299
North-West Europe, 226
South-East Asia

British Officers, 384

9

Q.A.LM.LN.S., 359, 386

All British Troops, 387

V.C.Os. and I.0.Rs., 363, 364, 388, 390
N.Cs.(E.), 363, 364, 389, 390
W.A.C.(I.) and I.M.N.S. 367, 391

All Indian Troops, 392

West African O.Rs., 371, 393

East African O.Rs., 372, 394

All Troops, 375, 395

British O.Rs., 403, 421
All British Troops, 404, 422
Indian Officers, 423
V.C.Os., and I.0.Rs., 405, 424
N.Cs.(E.), 425
I.M.LNSS., 426
All Indian Troops, 408, 409, 427
East African O.Rs., 410, 428
Ceylonese Officers, 411, 429
Ceylonese O.Rs., 411, 430
All Ceylonese Troops, 431
All Troops, 414, 432
United Kingdom
Male Troops, 123-124, 148, 150, 152, 154, 169
bronchitis, 123, 124
Female Troops, 143, 144, 159, 161, 163, 165
bronchitis, 144
comparison, Male and Female Troops, 166
admisions to medical units, British North African and Central Mediterranean
‘orce
All Troops, 238, 241, 244
African, 259, 271
British, 247, 262
Canadian, 250, 265
Indian, 256, 269
New Zealand, 253, 267
deaths in hospital
East Africa Command, 323
Middle East Force, 300, 301, 302, 303, 304, 305, 306, 307, 308, 309, 310}
By Commands, 311-314
United Kingdom, Male Troops, 157, Female Troops, 168
discharges on medical grounds
Male Troops, 440, 448, 449, bronchitis, 440
A.T.S., 452, 453
ethnic groups, comparative rates,
South-East Asia
Indo-Burma Front
V.C.Os. and I.0.Rs. and N.Cs. (E.), 364
B.O.Rs. and V.C.Os. and I.O.Rs., 380, 382, 399
All O.Rs., 400
Ceylon
B.O.R.s. and V.C.Os. and I.O.Rs., 416, 417, 435
B.O Rs. V.C.Os. and I.O.Rs. and Ceylonese O.Rs., 417, 419, 436
B.O.Rs., V.C.Os. and I.O.Rs., Ceylonese and E. African, 437
ethnic groups, relative susceptibility to,

INDEX 879

Middle East Force, bronchitis, 276, 277
South-East Asia, Ceylon, Ceylonese and Indian O.Rs., 419
invalidings, India Command, I.0.Rs., 339
medical evacuations to the United Kingdom
B.E.F. France, 1939-40, 174, 182, 184
India Command, B.O.Rs., bronchitis, 336
Royal Air Force, incidence in
Total Force, 477, 521, 529
bronchitis, 477, 529
by age groups, 578, 585
by trade groups, 588 590
Home Force, 493
bronchitis, 493
Forces Abroad, 509
bronchitis, 509
unsuitability of chronic bronchitic for service in tropical climates, 529
W.A.A.F., 610, 620, 621, 631
bronchitis, 610, 620
by age group, 623, 626
deaths, R.A.F., 599
W.A.A.F., 633
final invalidings, R.A.F., 595, 596
bronchitis, 595
W.A.A.F., 632
Emergency Medical Services
Service Patients
admissions to E.M.S. Hospitals, 679, 681-687, 725, 727, 729, 731, 733, 735,
737, 739
bronchitis, 681, 682, 683, 684, 725, 727, 729, 731, 733, 735, 737, 739
by sex and age group, 68:
duration of treatment, 685
Civilian Patients
admissions to E.M.S. Hospitals, 802, 803, 814-819
by sex and age group, 814-819

incidence and invalidings in, 17, 22, 27, 32, 37, 42, 47
deaths in, 17, 37, 42, 47
Haslar, R.N. Hospital, admissions to in First and Second World Wars, 81, 85
Army
admissions to Hospitals
B.E.F., France, 1939-40, British Troops, 173, 176, 177, 178, 179
East Africa Command, All Troops, 323
North-West Europe, 221, 226
United Kingdom
Male Troops, 148, 150, 152, 154, 169
Female Troops, 159, 161, 163, 165
deaths in hospital, United Kingdom, Male Troops, 157
discharges on medical grounds, Male Troops, 448, 449, A.T.S., 452, 453
medical evacuations to the United Kingdom, B.E.F., 1939-40, 181, 183
Royal Air Force
Total Force, 522, 537
high incidence in boy entrants and apprentices, 537
associated with upper respiratory infections, 537
and circulatory system disorders, 585
W.A.A.F., incidence in, 622
Emergency Medical Services
Service Patients
admissions to E.M.S. Hospitals, 664, 665, 666
investigation into association with streptococcal infections, 666, 668, 669

RUBELLA

Royal Navy
Total Force, incidence in, 17, 22, 27, 32, 37, 42, 47
Haslar, R.N. Hospital, admissions in First and Second World Wars, 81, 85

880 INDEX

Army
admissions to hospitals
B.E.F. France, 1939-40, 173, 176, 177, 178, 179
United Kingdom, Male Troops, 135, 148, 150, 152, 154
Female Troops, 145, 159, 161, 163, 165
comparative rates, Male and Female Troops, 166
admissions to medical units
North-West Europe, 223, 231
Air Force, incidence in
Total Force, 522, 537, 538
W.A.A.F., 607, 622
cy Medical Services
Service Patients, admissions to E.M.S. Hospitals, 662, 663, 664

SANDFLY FEVER (Phlebotomus Fever)

Revel Navy
‘otal Force, incidence in, 17, 22, 27, 32, 37, 42, 47
R.N. Hospital Haslar, admissions to, 85

admissions to hospitals
India Command
British Officers, 330, 331, 334
British Other Ranks, 330, 331, 334
Indian Officers, 331, 338
Indian Other Ranks, 331, 338
Middle East Force
All Troops, 275, 279, 280
Ethnic Groups, 282, 284, 285, 286, 287, 289
Other British Troops, 290
All Other Troops, 292
Women’s Services, 291
By Commands, 293, 295, 296, 298
South-East Asia
Indo-Burma Front
British Officers, 384
British O.Rs., 385
All British Troops, 387
V.C.Os. and I.0.Rs., 362, 388, 390
N.Cs.(E.), 363, 366, 389, 390
All Indian Troops, 392
West African O.Rs., 393
All Troops, 375, 395
Ceylon
British O.Rs., 421
All British Troops, 422
V.C.Os. and I.O.Rs., 406, 424
N.Cs.(E.), 425
All Indian Troops, 427
East African O.Rs., 410, 428
Ceylonese O.Rs., 412, 430
All Ceylonese Troops, 431
All Troops, 432
admissions to medical units
British North African and Central Mediterranean Force, peak incidence, 234
All Troops, 237, 241, 244
African, 259, 271
British, 236, 247, 262
Canadian, 250
Indian, 256, 269
New Zealand, 253, 267
ethnic groups comparative rates, South-East Asia
Indo-Burma Front
B.O.Rs. and V.C.Os. and I.O.Rs., 380, 382, 399
All Other Ranks, 400
Ceylon
British and Indian O.Rs., 417, 435

INDEX 881

British, Ceylonese, and Indian O.Rs., 436
British, Ceylonese, East African and Indian O.Rs., 437
ethnic groups, tibility to,
South East Asia, Indo-Burma Front, West African O.Rs., 383
high incidence, reasons for
in Indian Command, 329
in Cyprus, M.E.F., 277
Royal Air Force, incidence in, 544
India and A.C.S.E.A., 545
Iraq, 547
Middle East, 546
West Africa, 548

SCABIES
Army
admissions to hospitals
B.E.F. France, 1939-40, 173, 176, 177, 178, 179
India Command, more prevalent in I.0.Rs., 331, 338, B.O.Rs., 334
Middle East Force
All Troops, 275, 280
Ethnic Groups, 282, 284, 285, 286, 287, 289
Other British Troops, 290
All Other Troops, 292
Women’s Services, 291
by Commands, 293, 295, 296, 298, high incidence in Cyprus, 277
North-West Europe, 211, 226
South-East Asia Command
Indo-Burma Front
British Officers, 384
B.O.Rs., 357, 385
Q.A.LM.N.S., 386
All British Troops, 387
V.C.Os. and I.0.Rs., 365, 388, 390
N.Cs. (E.), 363, 365, 398, 390
W.A.C.(I.) and I.M.N.S., 367, 391
All Indian Troops, 392
West African O.Rs., 393
East African O.Rs., 394
All Troops, 375, 395
Ceylon
British Officers, 420
British O.Rs., 421
All British Troops, 422
V.C.Os. and I.0.Rs., 424
N.Cs.(E.), 406, 425
All Indian Troops, 427
East African O.Rs., 410, 428
Ceylonese Officers, 429
Ceylonese O.Rs. 430
All Ceylonese Troops, 431
All Troops, 414, 432
United Kingdom
Male Troops, 124, 148, 150, 152, 154, 169
Female Troops, 143, 159, 161, 163, 165
comparative rates, male and female, 166
admissions to medical units
British North African and Central Mediterranean Force, 234, 235
All Troops, 237, 241, 244
African, 236, 259, 271
British, 247, 262
Canadian, 250, 265
Indian, 236, 256, 269
New Zealand, 253, 267
North-West Europe, 217, 218, 231
ethnic groups, comparative rates, South-East Asia

882 INDEX

Indo-Burma
B.O.Rs. and V.C.Os. and LO.Rs., 380, 399

British and Indian O.Rs., 416, 417, 435
British, Ceylonese and Indian O.Rs., 436
British Ceylonese, East African and Indian O.Rs., 419, 437
medical evacuations to the United Kingdom
B.E.F. France, 1939-40, 181, 183
Royal Air Force, incidence in
‘otal Force, 481, 534
fall in incidence due to introduction of benzyl benzoate in 1942, 534
higher incidence in airmen than in officers, 594
Home Force, 497
Forces Abroad, 513
W.AAF., 614, 621
Medical Services
Service Patients
admissions to E.M.S. Hospitals, 660-662, 725, 727, 729, 731, 733, 735, 737, 739
by sex and age group,
duration of treatment, 661
Civilian Patients, admissions to E.M.S. Hospitals, 804

SCHISTOSOMIASIS
Army
admissions to hospitals
East Africa Command, All Troops, 323
Middle East Force
All Troops, 280
Ethnic Groups, 282, 284, 285, 287, 289
Other British Troops, 290
‘Women’s Services, 291
All Other Troops, 292
By Commands, 293, 295, 296, 298
West Africa
Europeans, 315, 316
West Africans, 315, 316
deaths in hospital
East Africa Command, All Ti , 323
Middle East Force, 300, 307, 31
ethnic groups, relative susceptibility
Middle East Force, 276, 277
SEPTIC CONDITIONS (See also SKIN and AREOLAR TISSUE, diseases of )
, admissions to hospitals, South-East Asia
Indo-Burma Front
British Officers, 353, 384
British O.Rs., 357, 385
Q.A.1.M.LN.S., 359, 386
All British Troops, 360, 387
V.C.Os. and 1.0.Rs., 362, 365, 388, 390
N.Cs. (E.), 363, 365, 389, 390
W.A.C.(I.) and LMNSS., 368, 391
All Indian Troops, 392
West African O.Rs., 371, 393
East African ORs.,: 372, 394
All Troops, 375, 395
Ceylon
British Officers, 401, 420
British O.Rs., 402, 421
All British Troops, 404, 422
Indian Officers, 423, 424
V.C.Os. and 1.0.Rs., 405
N.Cs.(E.), 425
ILM.NSS., 426
All Indian Troops, 408, 427
East African O.Rs., 410, 428

INDEX 883

Ceylonese Officers, 411, 429
Ceylonese O.Rs., 412, 430
All Ceylonese Troops, 431
All Troops, 414, 432
ethnic groups, comparative rates, South-East Asia
Indo-Burma
B.O.Rs. and V.C.Os. and I.0.Rs., 380, 382, 399
All O.Rs. 383, 400
Ceylon
B.O.Rs., V.C.Os. and I.0.Rs., 435
British, Ceylonese, Indian O.Rs., 436
British, Ceylonese, Indian and E. African O.Rs., 437
ethnic groups, relative susceptibility to, 418, 419
Royal Air Force, incidence in
Total Force, 475, 521, 524
by age groups, 577, 584
by trade groups, 588, 590, 592
Home Force, 491
Forces Abroad, 507
W.A.A.F., 609, 621, 631
by age groups, 623, 626
final invalidings, R.A.F., 596, W.A.A.F. 632

SKIN AND AREOLAR TISSUE, DISEASES OF, (See also Septic Conditions)
Royal Navy

incidence and invalidings in, 21, 24, 31, 35, 41, 45, 51
deaths in, 21, 24, 45, 51
ered R.N. Hospitals, admissions in First and Second World Wars, 81, 82, 83,
7

admissions to hospitals
B.E.F. France, 1939-40, 173, 180
impetigo, 173, 176, 177, 178
East Africa Command, All Troops, 323, British, 326
Middle East Force
All Troops, 275, 279, 281
By Ethnic Groups, 283, 284, 285, 286, 288, 289
Other British Troops, 290
All Other Troops, 592
Women’s Services, 291
By Commands, 294, 295, 297, 299
high incidence in certain Commands of, 278
North-West Europe, 193-195, 201, 202, 227, 230
South East Asia Command
Indo-Burma Front
British Officers, 353, 384
B.O.Rs., 357, 385
Q.A.LM.LN.S., 386
All British Troops, 387
V.C.Os. and I.0.Rs., 365, 388, 390
N.Cs. (E.), 363, 365, 389, 390
W.A.C.(I.) and I.M.N.S., 368, 391
All Indian Troops, 392
West African O.Rs., 371, 393
East African O.Rs., 372, 394
All Troops, 375, 395
Ceylon
British Officers, 401, 420
British O.Rs., 403, 421
All British Troops, 422
Indian Officers, 423
V.C.Os. and I.0.Rs., 405, 424
N.Cs.(E.), 407, 425
All Indian Troops, 427
East African O.Rs., 410, 428

884 INDEX

Ceylonese Officers, 429
Ceylonese O.Rs., 430
All Ceylonese Troops, 431
All Troops, 432
United Kingdom
Male Troops, 111, 113-115, 125, 148, 149, 150, 151, 152, 153, 154, 169
impetigo, 113, 114
dermatitis, 113, 114
Female Troops, 143, 160, 162, 164, 165
comparison Male and Female troops, 166
admissions to medical units
British North African and Central Mediterranean Force, 234, 235
All Troops, 237, 240, 241, 243, 244, 246
African, 259, 261, 271, 272
British, 236, 247, 249, 262, 264
Canadian, 250, 252, 265, 266
Indian, 256, 258, 269, 270
New Zealand, 253, 255, 267, 268
deaths in hospital
East Africa Command, All Troops, 323
Middle East Force, 300-310
By Commands, 311-314
United Kingdom, Male Troops, 158, Female Troops, 168
discharges on medical grounds
Male Troops, 442, 443, 448, 449
A.T.S., 452, 453
ethnic groups comparative rates, South-East Asia
Indo-Burma
B.O.Rs. and V.C.Os. and I.0.Rs., 380, 382, 399
All O.Rs., 383, 400
Ceylon
B.O.Rs., V.C.Os. and I.0.Rs., 416, 417, 435
B.O.Rs., Ceylonese O.Rs., V.C.Os. and I.0.Rs., 418, 436
British, East African, Ceylonese, Indian, O.Rs., 437
ethnic groups, relative susceptibility to
Middle East Force, British Troops, 276, 277
South East Asia, Ceylon, British Troops, 418, 419
medical evacuations to the United Kingdom
B.E.F., 1939-40, 174, 182, 184
Royal Air Force, incidence in
Total Force, 481, 521, 534
by age groups, 581, 586
by trade groups, 589, 591, 594
higher incidence in airmen than in officers, 594
final invalidings, 597
Home Force, 497
Forces Abroad, 513
more prevalent in hot climates, 534, 535
W.A.A.F., 614, 620, 621, 631
by age groups, 624, 629
final invalidings, 632
Emergency Medical Services
Service Patients, admissions to E.M.S. Hospitals, 714-718, 725, 727, 729, 731, 733,
735, 737, 739
by sex and age groups, 714
impetigo, 716, 717
Civilian Patients, admissions to E.M.S. Hospitals, 802, 803, 814-819
by sex and age groups, 814-819

SMALLPOX
Royal Navy
Total Force, incidence in, 17, 22, 27, 32, 37, 42, 47
deaths in, 27, 32, 37, 42, 47
Army
admissions to hospitals,
East Africa, ‘All Troops, 323

INDEX 885,

comparison between First and Second World Wars, 327
India, British Troops, 334, Indian Troops, 338
Middle East Force
All Troops, 280
British Troops, 282
Dominion Troops, 284
South African Troops, 285
New Zealand Troops, 286
Indian Troops, 287
British African Troops, 289
Other British Troops, 290
‘Women’s Services, ea
All Other Troops, 292
By Commands, 293, 295, 296, 298
South-East Asia
Indo-Burma Front
British Troops, 358, 384, 385, 386, 387
Indian Troops, 363, 367, 388, 389, 390, 391, 392
West African Troops, 371, 393
East African Troops, 372, 394
All Troops, 395
Ceylon
British Troops, 402, 403, 404, 420, 421, 422
Indian Troops, 407, 423, 424, 425, 426, 427
East African ‘Troops, 428
Ceylonese Troops, 412, 429, 430, 431
All Troops, 432
West Africa, 316
admissions to medical units
British North African and Central Mediterranean Force
All Troops, 237, 241, 244
British Troops, 247, 262
Indian Troops, 269
African Troops, 271
deaths in hospital
East Africa, All Troops, 323
India, B.O.Rs., 335
Middle East Force, 300, 301, 302, 303, 304, 305, 306, 307, 308, 309, 310
By Commands, 311, 312, 313, 314
West Africa, 321
ethnic groups, comparative rates, South-East Asia, V.C.Os. and I.O.Rs. 399
All O.Rs. 400, 437
British, Ceylonese, Indian O.Rs., 436
B.O.Rs. and V.C.Os., 435
ethnic groups, relative susceptibility to, in South-East Asia
Indo-Burma, 380, 382
Ceylon, 416, 418, 419
Royal Air Force
Total Force, incidence in, 537, 538

STRENGTHS
Armed Forces

1939-1945, total and yearly, 829. 830, 831
peak of mobilisation, 830, 831

Royal Navy
1939-1945, total and yearly, 829, 831, 832
average, Portsmouth Command, 83
average, Total Force, 17, 18, 20, 22, 24, 26, 27, 28, 30, 32, 34, 36, 37, 38, 40,

42, 44, 46, 47, 48, 50

peak of mobilisation, 831

Army
1939-1945, total and yearly, 829, 831, 832
peak of mobilisation, 831]
relative strength, M.E.F., 275

Royal Air Force
1939-1945, total and yearly, 829, 832

886 INDEX

average strength, Total Force, 469, 605
Force at Home, 470
Force Abroad, 470
by age groups, 569-571
by geographical area, 470, 471
Women’s Auxiliary Services
1939-1945, total and yearly, 829, 830, 832, 833
peak of mobilisation, 830, 831
Women’s Royal Naval Service
1939-1945, total and yearly, 830, 833
peak of mobilisation, 831, 832
Auxiliary Territorial Service
1939-1945, total and yearly, 830, 833
peak of mobilisation, 831
Women’s Auxiliary Air Force
1939-1945, total and yearly, 830, 833
average yearly, 605
peak of mobilisation, 831
Nursing Services, 1939-1945, 830, 833
peak of mobilisation, 831
Civilian Services
peak of mobilisation, men and women, 830, 831
Civil Defence
peak of mobilisation, men and women, 830, 831
1939-1945, total and yearly, 833
Merchant Navy
peak of mobilisation, 830, 831
Royal Observer Corps
1940-1944, men and women, 834
peak of mobilisation, men and women, 830, 831
Home Guard
1940-1944, men and women, 834
peak of mobilisation, 830, 831

incidence in 18, 23, 27, 32, 37, 42, 47
deaths, 23, 32, 42, 47
invalidings, 47
Haslar, R.N. Hospital, admissions during First and Second World Wars, 81, 85
Army
admissions to hospitals
B.E.F. France, 1939-40, 173, 176, 177, 178
India Command
British Officers and O.Rs., 334
Indian Officers and O.Rs., 338
Middle East Force
All Troops 280
Ethnic groups, 282, 284, 285, 286, 288, 289
Other British Troops, 290
All Other Troops, 292
Women’s Services, 291
By Commands, 294, 295, 297, 299, high incidence in certain commands, 278
North-West Europe, 191
South-East Asia
Indo-Burma Front
British Officers, 384
All British Troops, 387
Q.A.LMLN.S., 359, 386
V.C.Os. and I.O.Rs., 362, 388, 390
N.Cs.(E.), 363, 389, 390
W.A.C.(I.) and I.M.N.S., 368, 391
All Indian Troops, 392
West African O.Rs. 371, 393

INDEX

East African O.Rs. 372, 394
All Troops, 375, 395
Ceylon
British Officers, 401, 420
British O.Rs., 403, 421
All British Troops, 404, 422
Indian Officers, 423
V.C.Os. and I.0.Rs. 405, 424
N.Cs.(E.), 407, 425
I.M.N.S., 426
All Indian Troops, 409, 427
East African O.Rs., 428
Ceylonese Officers, 429
Ceylonese O.Rs., 412, 430
All Ceylonese Troops, 431
All Troops, 414, 432

United Kingdom

Male Troops, 115, 116, 169
Female Troops, 140

ethnic groups, comparative rates

Sou
B.O.Rs. V.C.Os. and I.O.Rs., 416, 417, 435
B.O.Rs. V.C.Os. and I.O.Rs. and Ceylonese O.Rs., 418, 436

East Asia, Ceylon

887

B.O.Rs., V.C.Os. and I.O.Rs. and Ceylonese O.Rs., and E. African O.Rs.,

437

ethnic groups, relative susceptibility
Middle East Force, 276, 277
South-East Asia, Ceylon, 418, 419

medical evacuations to the United Kingdom, B.E.F. France, 1939-40. 182,

Air Force, incidence in

Total Force, 475
Home Force, 491
Forces Abroad, 507
W.A.A.F., 608
TUBERCULOSIS
Royal Navy

pulmonary

Total Force

incidence, 15, 18, 23, 28, 33, 38, 43, 48

invalidings, 15, 16, 18, 23, 28, 33, 38, 43, 48, 54, 55, 57, 60, 62, 64, 73, 79

mass fluorography, introduction of, 15, 57
deaths, 18, 23, 28, 33, 38, 43, 48, 57, 58, 75, 76, 77

W.R.N.S., invalidings, 78, 79
R.N. Hospital, Haslar, admissions, 81, 85
non-pulmonary

Total Force

incidence, 18, 23, 28, 33, 38, 43, 48

invalidings, 18, 23, 28, 33, 38, 43, 48, 62, 73, 79

deaths, 18, 23, 28, 33, 38, 43, 48

W.R.NSS., invalidings, 78, 79
R.N. Hospital, Haslar, admissions, 81, 85

Army

admissions to hospitals
B.E.F. France, 1939-40

East Africa Command, All Troops, 323, British Troops, 325

pulmonary, 173, 176, 177, 178, 179
non-pulmonary, 179

India Command

British Officers, 334
British O.Rs., 334
Indian Officers, 338
Indian O.Rs., 338

Middle East Force

All Troops, 280

888 INDEX

Ethnic Groups, 282, 284, 285, 286, 287, 289
Other British Troops, 290
All Other Troops, 292
Women’s Services, 291
By Commands, 293, 295, 296, 298
North-West Europe, pulmonary and non-pulmonary, 226
South-East Asia
Indo-Burma Front
British Officers, 354, 384
British O.Rs., 358, 385
Q.A.LM.N.S., 386
All British Troops, 387
N.C.Os. and I.0.Rs., 362, 388, 390
N.Cs.(E.), 363, 367, 389, 390
W.A.C.(I.) and I.M.N.S., 367, 391
All Indian Troops, 367, 392
West African O.Rs., 371, 393
East African O.Rs., 372, 394
All Troops, 395
lon
British Officers, 402, 420
British O.Rs., 421
All British Troops, 422
Indian Officers, 423
V.C.Os. and 1.0.Rs., 405, 424
N.Cs.(E.), 407, 425
All Indian Troops, 409, 427
East African O.Rs., 410, 428
Ceylonese Officers, 411, 429
Ceylonese O.Rs., 412, 430
All Ceylonese Troops, 431
All Troops, 432
West Africa, Europeans and West Africans, 316
United Kingdom
Male Troops, 135, 148, 150, 152, 154, 166
Female Troops, 146, 159, 161, 163, 165, 166, 169
admissions to medical units
British North African and Central Mediterranean Force
All Troops, 237, 241, 244
African Troops, 236, 259, 271
British Troops, 247, 262
Canadian Troops, 250, 265
Indian Troops, 236, 256, 269
New Zealand Troops, 253, 267
North-West Europe, 223, 231
deaths in hospital
East Africa Command, 323
India Command
B.O.Rs. pulmonary, 332, 335
1.0.Rs. pulmonary, 332, 339
non-pulmonary, 339
comparison pulmonary, B.O.Rs. and I.O.Rs., 342
Middle East Force
All Troops, 278, 300
Ethnic Groups, 301, 307
Other British Troops, 308
Women’s Services, 309
All Other Troops, 310
By Commands, 311-314
West Africa, 320, 321
United Kingdom
Female Troops, 147, 168
Male Troops, 138, 157
discharges on medical grounds
Male troops, pulmonary, 441
non-pulmonary, 441

INDEX 889

A.T.S., 416, 447, 452, 453
ethnic ps, comparative rates,
South-East Asia
Indo-Burma Front
B.O.Rs. and V.C.Os. and I.0.Rs. 380, 382, 399
All O.Rs., 400
Ceylon
British and Indian O.Rs., 416, 417, 435
British, Ceylonese and Indian O.Rs., 418, 436
British, Ceylonese, E. African and Indian O.Rs. 419, 437
ethnic groups, relative susceptibility to
in Midde East Force, 276, 77, 278
in South-East Asia, Indo-Burma Front, 383, Ceylon, 418, 419

greece 332, 339
non-pulmonary, '339
comparison between B.O.Rs. and 1.0.Rs., 343
West Africa, West African Troops, 319, 320
medical evacuations to the United Kingdom
B.E.F., France, 1939-40, 174
pulmonary, 181, 183
non-pulmonary, 181, 183
India, pulmonary, B.O.Rs., 331, 336
West Africa, Europeans, 319, 320
Air Force, incidence in
Total Force
pulmonary, 475, 521, 523, 574
non-pulmonary, 475, 521, 523, 574
all types, by trade group, 587, 588, 590
effect of mass radiography on incidence in, 523, 573
high incidence in under 20 age group, 573, 574
Home Force
pulmonary, 491
non-pulmonary, 491
Forces Abroad
pulmonary, 507
non-pulmonary, 507
India and A.C.S.E.A., all types, 545
raq, all types, 547
Middle East, all types, 546
West Africa, all types, 548
W.A.A.F., higher incidence than in R.A.F., 607
pulmonary, 609, 621, 625
non-pulmonary, 609, 621, 625
r all types, high incidence in under 20 age group, 623, 625
leaths
R.A.F., highest cause of death from disease, 598, 599
W.A.A.F., highest cause of death from disease, 633
final invalidings
R.A.F. pulmonary, 595, 596, non-pulmonary, 595, 596
W.A.A.F. all types, 632, 633
Emergency Medical Services
Service Patients
admissions to E.M.S. Hospitals, 651-654, 725, 727, 729, 731, 733, 735, 737, 739
by sex and age groups, all forms, 651, 652
deaths, 653, 654
TYPHUS FEVER
Army
admissions to hospitals,
India Command, B.O.Rs., 334, Indian Officers, and O.Rs., 338
Middle East Force
All Troops, 280
Ethnic groups, 282, 284, 285, 286, 287, 289

890 INDEX

Other British Troops, 290
Women’s Services, 291
All Other Troops, 292
By Commands, 293, 295, 296, 298
deaths in hospital
India Command, B.O.Rs. 335
Middle East Force
All Troops, 300
Ethnic Groups, 301, 302, 303, 304, 305, 306, 307
Other British Troops, 308
All Other Troops, Bro
By Commands, 311-314
Royal Air Force
Total Force, incidence in, 537, 539
UNDULANT FEVER
Royal Navy
Total Force, incidence in, 18, 23, 28, 33, 38, 43, 48
Haslar, R.N. Hospital, admissions in First and Second World Wars, 85

admissions to hospitals,
East Africa, All Troops, 323
admissions to medical units,
British North African and Central Mediterranean Force
All Troops, 237, 241, 244
British Troops, 247, 262
New Zealand Troops, 267
Indian Troops, 269
African Troops, 271

URINARY SYSTEM, DISEASES OF, (Sce Genito-Urinary System, Diseases of)

VACCINIA AND POST INOCULATION EFFECTS
Royal Air Force, incidence in
Total Force, 475, 523, 573, 575
by age groups, 573, 575
vaccination and inoculation against certain infectious diseases, 523, 524, 573
Home Force, 491
Forces Abroad, 507
W.A.A.F., 609
by age groups, 623, 625
VENEREAL DISEASES
Navy
Total Force
incidence in, 14, 15, 18, 23, 28, 38, 43, 48
invalidings, 18, 23, 28, 33, 38, 43, 48
deaths, 18, 43
Haslar, R.N. Hospital, admissions in First and Second World Wars, 14, 15

admissions to hospitals
B.E.F. France, 1939-40, 173, 176, 177, 178, 179
or Africa, All Troops, 323, 324, British Troops, 325
ndia

British Troops, 330, 333, 334, 343
Indian Troops, 330, 331, 333, 338, 343

Middle East Force
All Troops, 275, 279, 280
U.K. Troops, 282
Dominion Troops, 284
South African Troops, 285
New Zealand Troops, 286
Indian Troops, 287
British African Troops, 289
Other British Troops, 290
All Other Troops, 292
Women’s Services, 291
By Commands, 293, 295, 296, 298, high incidence in certain Commands, 277

INDEX

North-West Europe, 188, 192, 193, 226
South-East Asia
Indo-Burma Front
British Troops, 356, 384, 385, 387
Inctan Troops , 361, 363, 364, 388, 389, 390, 392
W.A.C.(I.) and LM.N. 8., 391
West African Troops, 370, 393
East African Troops, 372, 394
All Troops, 374, 395
Ceylon
British Troops, 401, 402, 420, 421, 422
Indian Troops, 405, 406, 408, 423, 424, 425, 427
East African Troops, 410, 428
Ceylonese Troops, 412, 429, 430, 431
All Troops, 414, 432
bir 316, 318, 319
Europeans, 316, 318,
West Africans, 316, 318, 319
United Kingdom
Male Troops, 118, 119, 148, 150, 152, 154, 169
Female Troops, 159, 161, 163, 165
comparison, male and female troops, 166
admissions to medical units

British North African and Central Mediterranean Force, 232, 233, 235, 236,
237, 240, 241, 243, 244, 246, 247, 249, 250, 252, 253, 254, 255, 256, 258, 259,

261, 265, 267, 269, 270, 27, 273
All Troops, 237, 240, 241, 243, 244, 246
African Troops, 936, "259, 261, ON, 272
British Troops, 236, 247, 249, 262, 264
Canadian Troops, 236, 250, 252, 265, 266
Indian Troops, 236, 256, 258, 269, 270
New Zealand Troops, 236, 253, 255, 267, 268
North-West Europe, 216, 217, 231
deaths in hospital,
East Africa Command, 323, 324
India Command, B.O.Rs., 335
Middle East Force, 300-310
By Commands, 311-314
United Kingdom
Male Troops, 157
Female Troops, 168
is on medical grounds
Male Troops, 449, A.T.S., 453
ethnic groups, comparison of incidence in
India, B.O.Rs. and I.0.Rs., 330, 332, 343
South-East Asia
Indo-Burma Front
V.C.Os. and I.0.Rs, and N.Cs.(E).,
B.O.Rs. and V.C.Os. and I.0.Rs. i008 382, 399
All O.Rs., 400
lon
British and Indian O.Rs., 416, 417, 435
British, Ceylonese and Indian O.Rs. 418, 430
British, East African, Ceylonese and Indian O.Rs. 437
ethnic groups, relative susceptibility to
Middle East Force, African domiciled Troops, 276, 277
South-East Asia
Indo-Burma Front, 383
Ceylon, British, 418, 419
West Africa, West Africans, 315
invalidings
India, t O.Rs., 339
West Africa, West Africans, 319
medical evacuations to the United Kingdom
B.E.F. France, 1939-40, 174, 181, 183
West Africa, Europeans, 319

892 INDEX

Royal Air Force, incidence in,
Total Force, 475, 521, 524-527, 536
average duration of treatment
gonorrhoea, 525, 526, 536
syphilis, 526, 527, 536
average number of sick daily, 536
by age groups, 573, 575
by trade groups, 587, 588, 590
final invalidings, 596
Home Force, 491, 536
average duration of treatment, 536
average number sick daily, 536
Forces Abroad, 507, 536
average duration of treatment, 536
average number sick daily, 536
India and A.C.S.E.A., 545
Iraq. 547
Middle East, 546
West Africa, 548
W.A.A.F., 609, 620, 621, 630, 631
by age group, 623, 625
final invalidings, 632
Emergency Medical Services
Service Patients
admissions to E.M.S. Hospitals, 655-656, 725, 727, 729, 731, 733, 735, 737, 739
by sex and age group, 655
Civilian Patients, admissions to E.M.S. Hospitals, 804
WOMEN’S AUXILIARY AIR FORCE, (See Women’s Auxiliary Services)
WOMEN’S ROYAL NAVAL SERVICE, (See Women’s Auxiliary Services)

WOMEN’S AUXILIARY SERVICES, general survey of casualties in,
Armed Forces
Strengths, 832, 833
Casualties,
killed, missing, wounded, p.o.w. and internees, 836, 838
Civilian Services
Strengths, 833
Casualties,
killed, missing, believed killed, injured, 838, 839

Women’s Royal Naval Service
analysis of invalidings and deaths due to disease, 77-79
killed and wounded, 838
Auxiliary Territorial Services and Army Nursing Services
admissions to hospitals,
India, Q.A.I.M.N.S. and W.A.C (I.), 332, 333, 348
Middle East Force, 291
South-East Asia
Indo-Burma Front
Q.A.ILLM.N.S., 358, 359, 386, 396
W.A.C.(I.) and (I.M.N.S.), 367, 391, 396
Ceylon, I.M.N.S., 407, 426, 433
United Kingdom, 139-147, 159-168
deaths in hospitals
India, Q.A.I.M.N.S., 332, 348
W.A.G.(L), 332, 348
Middle East Force, 309
South-East Asia, Indo-Burma Front
W.A.C.(I) and I.M.N.S., 398
United Kingdom, 147, 168
discharges on medical grounds, 446, 447, 452, 453
invaliding, India, W.A.C.(I.), 333, 348
medical evacuations to the United Kingdom
India, Q.A.I.M.N.S., 332, 348
killed, missing, wounded, p.o.w., 838

INDEX 893

Women’s Auxiliary Air Force, incidence of diseases and injuries in, 601-633
Total Sickness, 605
excluding 48 hours and under, 605, 607-622
by age groups, 623-629
deaths, 606, 633
final invalidings, 606, 630, 632, 633
killed, missing, wounded, 838
Female Service Patients admitted to E.M.S. Hospitals, 647-768, 777-783
Civil Defence, Female personnel, 805, 806
killed and missing believed killed, 838
injured and detained in hospital, 838
WORLD HEALTH ORGANISATION, International Statistical Classification of Diseases,
Injuries and Causes of Death
Royal Navy, 14, Royal Air Force, 462, E.M.S., 642
YAWS
Army
East Africa, admissions to hospital, 323
West Africa, invalidings, African Troops, 319

bigtzed ty GOORTe

UNIVERSITY OF MICHIGAN

MONAT

3 9015 05207 2

DATE DUE

UNIVERSITY OF MICHIG:

MN TO

3 9015 05207 2